Provider Demographics
NPI:1013789619
Name:YANG, YER MOUA (PHARM D)
Entity Type:Individual
Prefix:
First Name:YER
Middle Name:MOUA
Last Name:YANG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:YER
Other - Middle Name:
Other - Last Name:MOUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8841 LAUGHLIN AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-3413
Mailing Address - Country:US
Mailing Address - Phone:209-684-2897
Mailing Address - Fax:
Practice Address - Street 1:1175 W LATHROP RD
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-8326
Practice Address - Country:US
Practice Address - Phone:209-825-4685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist