Provider Demographics
NPI:1720362510
Name:YEUNG, NICOLE NGOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:NGOC
Last Name:YEUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:NGOC
Other - Last Name:VUU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4218 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2916
Mailing Address - Country:US
Mailing Address - Phone:314-371-4286
Mailing Address - Fax:314-371-4749
Practice Address - Street 1:4218 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2916
Practice Address - Country:US
Practice Address - Phone:314-371-4286
Practice Address - Fax:314-371-4749
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005024428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist