Provider Demographics
NPI:1902592397
Name:SUN, XIAOFAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:XIAOFAN
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13660 W 6TH AVE APT A306
Mailing Address - Street 2:
Mailing Address - City:AIRWAY HEIGHTS
Mailing Address - State:WA
Mailing Address - Zip Code:99001-5189
Mailing Address - Country:US
Mailing Address - Phone:929-354-4377
Mailing Address - Fax:
Practice Address - Street 1:13660 W 6TH AVE APT A306
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001-5189
Practice Address - Country:US
Practice Address - Phone:929-354-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61396745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist