Provider Demographics
NPI:1689279564
Name:YANG, SERXIA (RPH)
Entity Type:Individual
Prefix:DR
First Name:SERXIA
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 RIDGEDALE DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1809
Mailing Address - Country:US
Mailing Address - Phone:952-542-8266
Mailing Address - Fax:952-356-3941
Practice Address - Street 1:13201 RIDGEDALE DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1809
Practice Address - Country:US
Practice Address - Phone:952-542-8266
Practice Address - Fax:952-356-3941
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy