Provider Demographics
NPI:1558818526
Name:YICK, PRISCILLA JONGMAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:JONGMAN
Last Name:YICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 RICHMOND CT N
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2746
Mailing Address - Country:US
Mailing Address - Phone:908-461-0741
Mailing Address - Fax:
Practice Address - Street 1:109 RICHMOND CT N
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2746
Practice Address - Country:US
Practice Address - Phone:908-461-0741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03813700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist