Provider Demographics
NPI:1205051109
Name:YANEZ, JOSE MIGUEL (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MIGUEL
Last Name:YANEZ
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 RUE BAYONNE
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1231
Mailing Address - Country:US
Mailing Address - Phone:985-727-7494
Mailing Address - Fax:985-641-7357
Practice Address - Street 1:140 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2030
Practice Address - Country:US
Practice Address - Phone:985-641-7557
Practice Address - Fax:985-641-7357
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist