Provider Demographics
NPI:1982206652
Name:YU, SHIRLEY YAN WAH
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:YAN WAH
Last Name:YU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CLOCKTOWER DR UNIT 5408
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-7882
Mailing Address - Country:US
Mailing Address - Phone:617-849-0347
Mailing Address - Fax:
Practice Address - Street 1:55 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-8517
Practice Address - Country:US
Practice Address - Phone:781-642-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist