Provider Demographics
NPI:1760472716
Name:YAN PHARMACY
Entity Type:Organization
Organization Name:YAN PHARMACY
Other - Org Name:PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAI
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:619-267-0768
Mailing Address - Street 1:2220 E PLAZA BLVD
Mailing Address - Street 2:STE L
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5161
Mailing Address - Country:US
Mailing Address - Phone:619-267-0768
Mailing Address - Fax:619-267-1197
Practice Address - Street 1:2220 E PLAZA BLVD
Practice Address - Street 2:STE L
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-5161
Practice Address - Country:US
Practice Address - Phone:619-267-0768
Practice Address - Fax:619-267-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY471513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2113504OtherPK
2113504OtherPK