Provider Demographics
NPI:1467555797
Name:VERCELLINE, YUNGA
Entity Type:Individual
Prefix:MS
First Name:YUNGA
Middle Name:
Last Name:VERCELLINE
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:PO BOX 2135
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-2135
Mailing Address - Country:US
Mailing Address - Phone:907-543-6364
Mailing Address - Fax:907-543-6306
Practice Address - Street 1:700 CHIEF EDDIE HOFFMAN HIGHWAY
Practice Address - Street 2:YKHC PHARMACY
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0287
Practice Address - Country:US
Practice Address - Phone:907-543-6364
Practice Address - Fax:907-543-6306
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist