Provider Demographics
NPI:1396030813
Name:YANNIELLO, KEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:
Last Name:YANNIELLO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9990 DALLAS PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4135
Mailing Address - Country:US
Mailing Address - Phone:214-291-5087
Mailing Address - Fax:972-608-2933
Practice Address - Street 1:9990 DALLAS PKWY STE 115
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4135
Practice Address - Country:US
Practice Address - Phone:214-291-5087
Practice Address - Fax:972-608-2933
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist