Provider Demographics
NPI:1770186058
Name:GAO, XIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:XIN
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5344
Mailing Address - Country:US
Mailing Address - Phone:408-981-5880
Mailing Address - Fax:
Practice Address - Street 1:413 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-5344
Practice Address - Country:US
Practice Address - Phone:408-981-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27543183500000X
NJ28RI04118700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist