Provider Demographics
NPI:1164206421
Name:NA, JOANN YEALIM (RPH)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:YEALIM
Last Name:NA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MCGRATH HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4503
Mailing Address - Country:US
Mailing Address - Phone:617-776-3000
Mailing Address - Fax:617-776-1491
Practice Address - Street 1:14 MCGRATH HWY STE 3
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4503
Practice Address - Country:US
Practice Address - Phone:617-776-3000
Practice Address - Fax:617-776-1491
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist