Individual
EDWIN MA THAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11850 BLACKFOOT ST NW STE 190, COON RAPIDS, MN 55433-2583
(763) 236-7111
Mailing address
18212 79TH PL N, MAPLE GROVE, MN 55311-1911
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
125332
MN
183500000X
Pharmacist
79678
CA
Other
Enumeration date
10/23/2018
Last updated
09/12/2022
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