Provider Demographics
NPI:1649900804
Name:YI, EUNKYO (RPH)
Entity type:Individual
Prefix:
First Name:EUNKYO
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 DOWDELL AVE UNIT 232
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-4114
Mailing Address - Country:US
Mailing Address - Phone:971-716-4204
Mailing Address - Fax:
Practice Address - Street 1:6340 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2404
Practice Address - Country:US
Practice Address - Phone:707-855-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87669183500000X
CAINT49493183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Yes183500000XPharmacy Service ProvidersPharmacist