Provider Demographics
NPI:1780856773
Name:YASKANICH, JOHN STEVEN JR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEVEN
Last Name:YASKANICH
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:STEVEN
Other - Last Name:YASKANICH
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2227 TUCKER LANE
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2600
Mailing Address - Country:US
Mailing Address - Phone:970-570-6867
Mailing Address - Fax:
Practice Address - Street 1:160 N HWY 491
Practice Address - Street 2:NORTHERN NAVAJO MEDICAL CENTER OUTPATIENT PHARMACY
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-0160
Practice Address - Country:US
Practice Address - Phone:970-570-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03311655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist