Provider Demographics
NPI:1134432792
Name:MO, QIUHUA ANGEL
Entity type:Individual
Prefix:
First Name:QIUHUA
Middle Name:ANGEL
Last Name:MO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W 42ND ST APT 18C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6845
Mailing Address - Country:US
Mailing Address - Phone:718-406-4613
Mailing Address - Fax:
Practice Address - Street 1:420 W 42ND ST APT 18C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6845
Practice Address - Country:US
Practice Address - Phone:718-406-4613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050002-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist