Provider Demographics
NPI:1457613408
Name:KAAKEH, YAMAN (PHARMD,BCPS,BCNSP)
Entity Type:Individual
Prefix:DR
First Name:YAMAN
Middle Name:
Last Name:KAAKEH
Suffix:
Gender:F
Credentials:PHARMD,BCPS,BCNSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 STADIUM MALL DR # 502D
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 STADIUM MALL DR # 502D
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2091
Practice Address - Country:US
Practice Address - Phone:765-494-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021991A183500000X
MI5302036315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist