Provider Demographics
NPI:1467961953
Name:XIONG, ROBERT JOHN (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:XIONG
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7405
Mailing Address - Country:US
Mailing Address - Phone:916-476-1038
Mailing Address - Fax:
Practice Address - Street 1:3933 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7405
Practice Address - Country:US
Practice Address - Phone:916-476-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist