Provider Demographics
NPI:1336903822
Name:YAGA, CARTHIC
Entity Type:Individual
Prefix:
First Name:CARTHIC
Middle Name:
Last Name:YAGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8193 BRIAR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5256
Mailing Address - Country:US
Mailing Address - Phone:925-765-7091
Mailing Address - Fax:
Practice Address - Street 1:3121 DIABLO AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2701
Practice Address - Country:US
Practice Address - Phone:855-910-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist