Provider Demographics
NPI:1366849895
Name:QIAN, QIAN (RPH)
Entity Type:Individual
Prefix:
First Name:QIAN
Middle Name:
Last Name:QIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 WINDING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1110
Mailing Address - Country:US
Mailing Address - Phone:702-806-0619
Mailing Address - Fax:
Practice Address - Street 1:1418 E PROSPERITY AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-8054
Practice Address - Country:US
Practice Address - Phone:559-684-7963
Practice Address - Fax:559-684-7967
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist