Provider Demographics
NPI:1073917100
Name:YEO, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:YEO
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 1:650 W 42ND ST
Mailing Address - Street 2:#2613
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4343
Mailing Address - Country:US
Mailing Address - Phone:972-697-8086
Mailing Address - Fax:
Practice Address - Street 1:650 W 42ND ST
Practice Address - Street 2:#2613
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4343
Practice Address - Country:US
Practice Address - Phone:972-697-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03669600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist