MEDICARE: DR. LEO YUAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	71097	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71097	OTHER	CA	CALIFORNIA BOARD OF PHARMACY DHHS

General Provider Information

NPI Number	:	1679977789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO YUAN PHARMD

Provider Business Mailing Address
First Line	:	4610 SONOMA HWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-4137
Country	:	US
Telephone Number	:	707-538-9275
Fax Number	:

Provider Business Practice Location Address
First Line	:	4610 SONOMA HWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-4137
Country	:	US
Telephone Number	:	707-538-9275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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