Healthcare Provider Details

I. General information

NPI: 1851666556
Provider Name (Legal Business Name): MARY QING MIAO PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

2194 SIERRA RD
SAN JOSE CA
95131-2677
US

V. Phone/Fax

Practice location:
  • Phone: 626-246-5769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65845
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number65845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: