Provider Demographics
NPI:1841812195
Name:JIANG, MICHELLE QING
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:QING
Last Name:JIANG
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 1:1063 GARRISON LN
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2299
Mailing Address - Country:US
Mailing Address - Phone:215-470-2619
Mailing Address - Fax:
Practice Address - Street 1:1515 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-1301
Practice Address - Country:US
Practice Address - Phone:215-997-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045574L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP045574LOtherSTATE LICENSE