Provider Demographics
NPI:1629391487
Name:GAO, QIN (PHARM D/LAC)
Entity type:Individual
Prefix:
First Name:QIN
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:PHARM D/LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 PINNEBERG AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-1560
Mailing Address - Country:US
Mailing Address - Phone:914-659-0083
Mailing Address - Fax:
Practice Address - Street 1:2202 PINNEBERG AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1560
Practice Address - Country:US
Practice Address - Phone:914-659-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006463171100000X
NY053344183500000X
MDU02940171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No183500000XPharmacy Service ProvidersPharmacist