Provider Demographics
NPI:1356714737
Name:YANES, HAAJAR
Entity type:Individual
Prefix:
First Name:HAAJAR
Middle Name:
Last Name:YANES
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 1:2226 76TH ST
Mailing Address - Street 2:APT. C2
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1241
Mailing Address - Country:US
Mailing Address - Phone:973-262-1490
Mailing Address - Fax:
Practice Address - Street 1:2226 76TH ST
Practice Address - Street 2:APT. C2
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1241
Practice Address - Country:US
Practice Address - Phone:973-262-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03753100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist