Provider Demographics
NPI:1396331666
Name:XIONG, SHOUA NOU (RPH)
Entity type:Individual
Prefix:
First Name:SHOUA
Middle Name:NOU
Last Name:XIONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2712
Mailing Address - Country:US
Mailing Address - Phone:612-522-2383
Mailing Address - Fax:612-522-3573
Practice Address - Street 1:627 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2712
Practice Address - Country:US
Practice Address - Phone:612-522-2383
Practice Address - Fax:612-522-3573
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist