Provider Demographics
NPI:1508307349
Name:YANG, YI (PHARMD)
Entity Type:Individual
Prefix:
First Name:YI
Middle Name:
Last Name:YANG
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 1:11059 TIMBERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8772
Mailing Address - Country:US
Mailing Address - Phone:518-326-3276
Mailing Address - Fax:
Practice Address - Street 1:724 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-1506
Practice Address - Country:US
Practice Address - Phone:574-223-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025707A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist