Provider Demographics
NPI:1164509485
Name:RIAZ, YASIR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:YASIR
Middle Name:
Last Name:RIAZ
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10216 PAULSELL DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4362
Mailing Address - Country:US
Mailing Address - Phone:209-476-5420
Mailing Address - Fax:209-476-3716
Practice Address - Street 1:7373 WEST LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3377
Practice Address - Country:US
Practice Address - Phone:209-476-5420
Practice Address - Fax:209-476-3716
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist