Provider Demographics
NPI:1275815011
Name:SJAMSUDIN, YENI (PHARM D)
Entity Type:Individual
Prefix:
First Name:YENI
Middle Name:
Last Name:SJAMSUDIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46844 MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7943
Mailing Address - Country:US
Mailing Address - Phone:510-661-0167
Mailing Address - Fax:510-661-0271
Practice Address - Street 1:46844 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7943
Practice Address - Country:US
Practice Address - Phone:510-661-0167
Practice Address - Fax:510-661-0271
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH43102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist