Provider Demographics
NPI:1528592003
Name:QIN, ANGEL (RPH)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:QIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MERITAGE CMN
Mailing Address - Street 2:UNIT 203
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7578
Mailing Address - Country:US
Mailing Address - Phone:312-919-7712
Mailing Address - Fax:
Practice Address - Street 1:7 MERITAGE COMMON
Practice Address - Street 2:UNIT 203
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551
Practice Address - Country:US
Practice Address - Phone:312-919-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist