Healthcare Provider Details

I. General information

NPI: 1386942456
Provider Name (Legal Business Name): MARTIN YOON PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHWEST CORNER OF NAVAJO ROUTE 7 AND 12
FORT DEFIANCE AZ
86504-0649
US

IV. Provider business mailing address

PO BOX 649
FORT DEFIANCE AZ
86504-0649
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8328
  • Fax: 928-729-8348
Mailing address:
  • Phone: 928-729-8328
  • Fax: 928-729-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19487
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: