Healthcare Provider Details

I. General information

NPI: 1508311341
Provider Name (Legal Business Name): ANDREA YIM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S RURAL RD
TEMPE AZ
85282-5404
US

IV. Provider business mailing address

750 W BASELINE RD APT 2040
TEMPE AZ
85283-5929
US

V. Phone/Fax

Practice location:
  • Phone: 480-345-6328
  • Fax:
Mailing address:
  • Phone: 714-274-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022095
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: