Healthcare Provider Details

I. General information

NPI: 1972944627
Provider Name (Legal Business Name): SERGE YICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 PLEASANT RIDGE RD APT 214
LITTLE ROCK AR
72223-2399
US

IV. Provider business mailing address

11901 PLEASANT RIDGE RD APT 214
LITTLE ROCK AR
72223-2399
US

V. Phone/Fax

Practice location:
  • Phone: 217-390-2826
  • Fax:
Mailing address:
  • Phone: 217-390-2826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD12344
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: