Provider Demographics
NPI:1518241470
Name:YUAN, EDWARD (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:YUAN
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 1:4050 SUNRISE BLVD.
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742
Mailing Address - Country:US
Mailing Address - Phone:916-294-9566
Mailing Address - Fax:916-294-9572
Practice Address - Street 1:4050 SUNRISE BLVD.
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742
Practice Address - Country:US
Practice Address - Phone:916-294-9566
Practice Address - Fax:916-294-9572
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist