Provider Demographics
NPI:1700425873
Name:YANG, WANYU
Entity type:Individual
Prefix:
First Name:WANYU
Middle Name:
Last Name:YANG
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 1:4908 BURKEMONT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-7624
Mailing Address - Country:US
Mailing Address - Phone:828-443-9805
Mailing Address - Fax:
Practice Address - Street 1:1101 WOODRDG CTR DR STE 114
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2085
Practice Address - Country:US
Practice Address - Phone:704-424-5551
Practice Address - Fax:704-424-5612
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist