Healthcare Provider Details

I. General information

NPI: 1275250458
Provider Name (Legal Business Name): JESSICA YEE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12746 W JEFFERSON BLVD STE 3160
PLAYA VISTA CA
90094-2778
US

IV. Provider business mailing address

313 GRAND BLVD #1343
VENICE CA
90294
US

V. Phone/Fax

Practice location:
  • Phone: 310-862-9810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH86648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: