Healthcare Provider Details

I. General information

NPI: 1104008804
Provider Name (Legal Business Name): YULIYA KORCHNOY PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

34800 BOB WILSON DR
SAN DIEGO CA
92134
US

V. Phone/Fax

Practice location:
  • Phone: 818-448-2209
  • Fax:
Mailing address:
  • Phone: 818-448-2209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH57971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: