Provider Demographics
NPI:1093337529
Name:PAN, YANGDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YANGDA
Middle Name:
Last Name:PAN
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 1:15810 CARDINAL PT
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3489
Mailing Address - Country:US
Mailing Address - Phone:512-431-2836
Mailing Address - Fax:
Practice Address - Street 1:15810 CARDINAL PT
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-3489
Practice Address - Country:US
Practice Address - Phone:512-431-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist