Provider Demographics
NPI:1750939245
Name:OU, YAN (PHARMD)
Entity type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:OU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MARKETPLACE DR APT 621
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-2441
Mailing Address - Country:US
Mailing Address - Phone:702-769-3368
Mailing Address - Fax:
Practice Address - Street 1:9101 WOODWAY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3366
Practice Address - Country:US
Practice Address - Phone:254-399-6892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist