Provider Demographics
NPI:1760782064
Name:YAMAGUCHI, JAN LESLIE (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:LESLIE
Last Name:YAMAGUCHI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 EVERGREEN WAY
Mailing Address - Street 2:A-1
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6424
Mailing Address - Country:US
Mailing Address - Phone:425-355-9303
Mailing Address - Fax:425-355-9304
Practice Address - Street 1:7601 EVERGREEN WAY
Practice Address - Street 2:A-1
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6424
Practice Address - Country:US
Practice Address - Phone:425-355-9303
Practice Address - Fax:425-355-9304
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00011066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist