Provider Demographics
NPI:1639150998
Name:YUHONNE THOM
Entity Type:Organization
Organization Name:YUHONNE THOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:YUHON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-254-6839
Mailing Address - Street 1:5821 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2634
Mailing Address - Country:US
Mailing Address - Phone:323-254-6839
Mailing Address - Fax:
Practice Address - Street 1:5821 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-2634
Practice Address - Country:US
Practice Address - Phone:323-254-6839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY214030Medicaid
0513760001Medicare PIN
0513760001Medicare NSC