Provider Demographics
NPI:1932754587
Name:GAO, JIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JIA
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 1:23 OBSERVATION CT APT 203
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6415
Mailing Address - Country:US
Mailing Address - Phone:301-275-3633
Mailing Address - Fax:
Practice Address - Street 1:23 OBSERVATION CT APT 203
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6415
Practice Address - Country:US
Practice Address - Phone:301-275-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist