Provider Demographics
NPI:1154793602
Name:TAN, XIANGHAI (PHARMD)
Entity type:Individual
Prefix:
First Name:XIANGHAI
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12144 FLOWING WATER TRL
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1682
Mailing Address - Country:US
Mailing Address - Phone:443-293-2183
Mailing Address - Fax:
Practice Address - Street 1:22565 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-3054
Practice Address - Country:US
Practice Address - Phone:301-863-5992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist