MEDICARE: STACY XIE CHEN

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	71241	CA

General Provider Information

NPI Number	:	1285034066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY XIE CHEN

Provider Business Mailing Address
First Line	:	3860 DECOTO RD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-3112
Country	:	US
Telephone Number	:	510-793-9798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 CAMDEN AVE STE 101
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2944
Country	:	US
Telephone Number	:	650-437-0561
Fax Number	:

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

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	06/08/2022

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Directions to “ STACY XIE CHEN ” Practice Location

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