Provider Demographics
NPI:1760196307
Name:DUAN, QIAOYUAN (RPH)
Entity Type:Individual
Prefix:
First Name:QIAOYUAN
Middle Name:
Last Name:DUAN
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 1:2805 MARIGOLD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3543
Mailing Address - Country:US
Mailing Address - Phone:216-536-1502
Mailing Address - Fax:
Practice Address - Street 1:6259 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124-3217
Practice Address - Country:US
Practice Address - Phone:440-449-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist