Provider Demographics
NPI:1083173140
Name:MENG, AUDREY YEON-JOO (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:YEON-JOO
Last Name:MENG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:YEON-JOO
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7331 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4669
Mailing Address - Country:US
Mailing Address - Phone:503-720-5310
Mailing Address - Fax:
Practice Address - Street 1:3010 BERNAL AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6606
Practice Address - Country:US
Practice Address - Phone:925-462-9138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist