Provider Demographics
NPI:1568906352
Name:YESHIWAS, YEHENEW B
Entity Type:Individual
Prefix:
First Name:YEHENEW
Middle Name:B
Last Name:YESHIWAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1529
Mailing Address - Country:US
Mailing Address - Phone:408-250-2570
Mailing Address - Fax:
Practice Address - Street 1:23500 KASSON ROAD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95378
Practice Address - Country:US
Practice Address - Phone:209-835-4141
Practice Address - Fax:209-830-3807
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist