Provider Demographics
NPI:1164991345
Name:XIAO, YUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:YUE
Middle Name:
Last Name:XIAO
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 1:481 S MEADOWBROOK DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7752
Mailing Address - Country:US
Mailing Address - Phone:617-314-1205
Mailing Address - Fax:
Practice Address - Street 1:481 S MEADOWBROOK DR UNIT 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-7752
Practice Address - Country:US
Practice Address - Phone:617-314-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-17
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238198183500000X
CARPH79629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist