Provider Demographics
NPI:1619424629
Name:YANICAK, AMY JOY (PHARMD, MPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JOY
Last Name:YANICAK
Suffix:
Gender:F
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 6TH AVE SE
Mailing Address - Street 2:APT 304
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1064
Mailing Address - Country:US
Mailing Address - Phone:704-609-6870
Mailing Address - Fax:
Practice Address - Street 1:4410 6TH AVE SE
Practice Address - Street 2:APT 304
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1064
Practice Address - Country:US
Practice Address - Phone:704-609-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60665592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist