MEDICARE: XI W TAN PHARM.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	44592	TX

General Provider Information

NPI Number	:	1134406515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XI W TAN PHARM.D

Provider Business Mailing Address
First Line	:	2427 E EXPRESSWAY 83
Second Line	:	T-2237
City	:	MISSION
State	:	TX
Zip	:	78572-8354
Country	:	US
Telephone Number	:	956-928-7281
Fax Number	:

Provider Business Practice Location Address
First Line	:	2427 E EXPRESSWAY 83
Second Line	:	T-2237
City	:	MISSION
State	:	TX
Zip	:	78572-8354
Country	:	US
Telephone Number	:	956-928-7281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2011
Last Update Date	:	11/13/2011

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