Provider Demographics
NPI:1700114600
Name:YAGHI, BOUTHANA K
Entity Type:Individual
Prefix:MRS
First Name:BOUTHANA
Middle Name:K
Last Name:YAGHI
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 1:3601 W WILLIAM CANNON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1525
Mailing Address - Country:US
Mailing Address - Phone:512-892-0930
Mailing Address - Fax:512-892-2479
Practice Address - Street 1:3601 W WILLIAM CANNON DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1525
Practice Address - Country:US
Practice Address - Phone:512-892-0930
Practice Address - Fax:512-892-2479
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist