Provider Demographics
NPI:1922264878
Name:YU, RONG TIAN (RPH)
Entity Type:Individual
Prefix:
First Name:RONG TIAN
Middle Name:
Last Name:YU
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 1:1037 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-7346
Mailing Address - Country:US
Mailing Address - Phone:718-707-0705
Mailing Address - Fax:718-707-0706
Practice Address - Street 1:1037 41ST AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-7346
Practice Address - Country:US
Practice Address - Phone:718-707-0705
Practice Address - Fax:718-707-0706
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist