Provider Demographics
NPI:1811264989
Name:KOGAN, YANA (PHARMD,)
Entity type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:KOGAN
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 1:2648 GOUGH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4418
Mailing Address - Country:US
Mailing Address - Phone:201-679-0238
Mailing Address - Fax:
Practice Address - Street 1:2648 GOUGH ST APT 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4418
Practice Address - Country:US
Practice Address - Phone:201-679-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist