Provider Demographics
NPI:1659689313
Name:YAHNKE, REX ARTHUR
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:ARTHUR
Last Name:YAHNKE
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 1:801 TIOGA AVE
Mailing Address - Street 2:
Mailing Address - City:SAND CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93955-3050
Mailing Address - Country:US
Mailing Address - Phone:831-899-2481
Mailing Address - Fax:
Practice Address - Street 1:801 TIOGA AVE
Practice Address - Street 2:
Practice Address - City:SAND CITY
Practice Address - State:CA
Practice Address - Zip Code:93955-3050
Practice Address - Country:US
Practice Address - Phone:831-899-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist