Provider Demographics
NPI:1063151082
Name:TAMIDA, XIAOJIE X
Entity type:Individual
Prefix:DR
First Name:XIAOJIE
Middle Name:X
Last Name:TAMIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8622 GARVEY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3291
Mailing Address - Country:US
Mailing Address - Phone:626-280-2223
Mailing Address - Fax:626-280-8243
Practice Address - Street 1:8622 GARVEY AVE STE 102
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3291
Practice Address - Country:US
Practice Address - Phone:626-280-2223
Practice Address - Fax:626-280-8243
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist