Provider Demographics
NPI:1043786445
Name:XIONG, CAROLYN MAI DER (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MAI DER
Last Name:XIONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 131ST LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-1385
Mailing Address - Country:US
Mailing Address - Phone:763-754-6732
Mailing Address - Fax:763-754-6179
Practice Address - Street 1:1852 131ST LN NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-1385
Practice Address - Country:US
Practice Address - Phone:763-754-6732
Practice Address - Fax:763-754-6179
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist