Provider Demographics
NPI:1114227618
Name:GIN, ROSE YAMJONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:YAMJONG
Last Name:GIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2462
Mailing Address - Country:US
Mailing Address - Phone:510-235-0088
Mailing Address - Fax:510-235-0092
Practice Address - Street 1:4925 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2462
Practice Address - Country:US
Practice Address - Phone:510-235-0088
Practice Address - Fax:510-235-0092
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist