Healthcare Provider Details

I. General information

NPI: 1013789619
Provider Name (Legal Business Name): YER MOUA YANG PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YER MOUA

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 W LATHROP RD
MANTECA CA
95336-8326
US

IV. Provider business mailing address

8841 LAUGHLIN AVE
STOCKTON CA
95212-3413
US

V. Phone/Fax

Practice location:
  • Phone: 209-825-4685
  • Fax:
Mailing address:
  • Phone: 209-684-2897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: