Provider Demographics
NPI:1164056776
Name:XIONG, KELLY A (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
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 1:40950 N IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-8915
Mailing Address - Country:US
Mailing Address - Phone:480-758-3320
Mailing Address - Fax:
Practice Address - Street 1:40950 N IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85140-8915
Practice Address - Country:US
Practice Address - Phone:480-758-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0248851835P0018X
MEPR696401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist