Provider Demographics
NPI:1497024749
Name:YU, HAUTAK GINO (RPH)
Entity Type:Individual
Prefix:
First Name:HAUTAK
Middle Name:GINO
Last Name:YU
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 1:43543 20TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5961
Mailing Address - Country:US
Mailing Address - Phone:661-400-7529
Mailing Address - Fax:661-726-3388
Practice Address - Street 1:43543 20TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5961
Practice Address - Country:US
Practice Address - Phone:661-400-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist