Provider Demographics
NPI:1477036036
Name:BANAH, YASIR (PHARMD)
Entity Type:Individual
Prefix:
First Name:YASIR
Middle Name:
Last Name:BANAH
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 1:8230 SARATOGA WAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4581
Mailing Address - Country:US
Mailing Address - Phone:916-939-6439
Mailing Address - Fax:
Practice Address - Street 1:8230 SARATOGA WAY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4581
Practice Address - Country:US
Practice Address - Phone:916-939-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist