Provider Demographics
NPI:1336524289
Name:YI, PATRICIA (RPH, PHC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:RPH, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 BROADBENT PKWY NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1621
Mailing Address - Country:US
Mailing Address - Phone:505-639-5857
Mailing Address - Fax:505-639-5888
Practice Address - Street 1:2820 BROADBENT PKWY NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1621
Practice Address - Country:US
Practice Address - Phone:505-639-5857
Practice Address - Fax:505-639-5888
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000057881835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85881864Medicaid