Healthcare Provider Details

I. General information

NPI: 1255900312
Provider Name (Legal Business Name): ZI XUAN YANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 RISING SUN AVE
PHILADELPHIA PA
19120-3009
US

IV. Provider business mailing address

2918 SANDYFORD AVE
PHILADELPHIA PA
19152-4414
US

V. Phone/Fax

Practice location:
  • Phone: 215-329-0312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP455649
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: