Provider Demographics
NPI:1669546636
Name:LIANG, XIAOLAN
Entity type:Individual
Prefix:
First Name:XIAOLAN
Middle Name:
Last Name:LIANG
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 1:9 OAKBRIDGE CT APT 30
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2004
Mailing Address - Country:US
Mailing Address - Phone:608-836-4472
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:COMPLIANCE MAIL CODE 2433
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-662-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13262183500000X
CO15042183500000X
CA51658183500000X
WI30248191835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3024819OtherBOARD OF PHARMACEUTICAL
CA51658OtherPHARMACIST
CO15042OtherPHARMACIST
WI13262OtherPHARMACIST