Provider Demographics
NPI:1104173020
Name:XU, TONG
Entity type:Individual
Prefix:
First Name:TONG
Middle Name:
Last Name:XU
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 1:2433 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9735
Mailing Address - Country:US
Mailing Address - Phone:319-621-5096
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR. UNIV. OF IOWA HOSPITALS AND CLINICS
Practice Address - Street 2:DEPT. OF PHARMACEUTICAL CARE
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-356-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist