Provider Demographics
NPI:1629391487
Name:GAO, QIN (PHARM D/LAC)
Entity Type:Individual
Prefix:
First Name:QIN
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:PHARM D/LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-2308
Mailing Address - Country:US
Mailing Address - Phone:914-659-0083
Mailing Address - Fax:
Practice Address - Street 1:15 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-2308
Practice Address - Country:US
Practice Address - Phone:914-659-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053344183500000X
NY006463171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No183500000XPharmacy Service ProvidersPharmacist