Provider Demographics
NPI:1750986980
Name:XU, MICHELLE TONGJING (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TONGJING
Last Name:XU
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 1:9 SCHOBL ST
Mailing Address - Street 2:
Mailing Address - City:OTISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10963-2324
Mailing Address - Country:US
Mailing Address - Phone:317-879-6637
Mailing Address - Fax:
Practice Address - Street 1:56 W MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2243
Practice Address - Country:US
Practice Address - Phone:845-896-8665
Practice Address - Fax:845-896-8528
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist