Healthcare Provider Details

I. General information

NPI: 1659689313
Provider Name (Legal Business Name): REX ARTHUR YAHNKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 TIOGA AVE
SAND CITY CA
93955-3050
US

IV. Provider business mailing address

801 TIOGA AVE
SAND CITY CA
93955-3050
US

V. Phone/Fax

Practice location:
  • Phone: 831-899-2481
  • Fax:
Mailing address:
  • Phone: 831-899-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: