Provider Demographics
NPI:1518680339
Name:YANOSCHAK, JOHN MICHAEL I (BS PHARM, MBA, RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:YANOSCHAK
Suffix:I
Gender:M
Credentials:BS PHARM, MBA, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 WOODLANE RD
Mailing Address - Street 2:
Mailing Address - City:EASTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-9628
Mailing Address - Country:US
Mailing Address - Phone:609-702-3931
Mailing Address - Fax:
Practice Address - Street 1:1300 WOODLANE RD
Practice Address - Street 2:
Practice Address - City:EASTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-9628
Practice Address - Country:US
Practice Address - Phone:609-702-3931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01706000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist