Provider Demographics
NPI:1265833644
Name:YU, HENRY (PHARMD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:YU
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 1:177 S MILL DAM RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27921-7602
Mailing Address - Country:US
Mailing Address - Phone:252-562-0592
Mailing Address - Fax:
Practice Address - Street 1:717 N BROAD ST
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1430
Practice Address - Country:US
Practice Address - Phone:252-331-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24194183500000X
VA0202213435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist