Provider Demographics
NPI:1174976765
Name:XIA, CONGSHAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CONGSHAN
Middle Name:
Last Name:XIA
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 1:13655 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8521
Mailing Address - Country:US
Mailing Address - Phone:760-949-8930
Mailing Address - Fax:760-949-9247
Practice Address - Street 1:13655 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-8521
Practice Address - Country:US
Practice Address - Phone:760-949-8930
Practice Address - Fax:760-949-9247
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist