Provider Demographics
NPI:1902400633
Name:BAI, YAN (RPH)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:BAI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:BAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:350 ABBOTTS MILL DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8425
Mailing Address - Country:US
Mailing Address - Phone:512-203-6123
Mailing Address - Fax:
Practice Address - Street 1:2500 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-3055
Practice Address - Country:US
Practice Address - Phone:770-394-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist