Provider Demographics
NPI:1295028215
Name:YANG, KINARA SARA
Entity Type:Individual
Prefix:
First Name:KINARA
Middle Name:SARA
Last Name:YANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 STOCKWELL DR
Mailing Address - Street 2:COSTCO AVON
Mailing Address - City:AVON
Mailing Address - State:MA
Mailing Address - Zip Code:02322-1149
Mailing Address - Country:US
Mailing Address - Phone:508-232-4003
Mailing Address - Fax:
Practice Address - Street 1:120 STOCKWELL DR
Practice Address - Street 2:COSTCO AVON
Practice Address - City:AVON
Practice Address - State:MA
Practice Address - Zip Code:02322-1149
Practice Address - Country:US
Practice Address - Phone:508-232-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist