Provider Demographics
NPI:1730465279
Name:WAN, XIN (RPH)
Entity Type:Individual
Prefix:
First Name:XIN
Middle Name:
Last Name:WAN
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 1:20812 BOTHELL EVERETT HWY
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8404
Mailing Address - Country:US
Mailing Address - Phone:425-398-0204
Mailing Address - Fax:425-481-7845
Practice Address - Street 1:20812 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8404
Practice Address - Country:US
Practice Address - Phone:425-398-0204
Practice Address - Fax:425-481-7845
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60237474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist