Healthcare Provider Details

I. General information

NPI: 1124579081
Provider Name (Legal Business Name): YI WANG PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 E 120TH AVE
THORNTON CO
80233-6701
US

IV. Provider business mailing address

16628 E 111TH CIR
COMMERCE CITY CO
80022-9098
US

V. Phone/Fax

Practice location:
  • Phone: 303-451-9470
  • Fax: 303-450-3427
Mailing address:
  • Phone: 314-401-2432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0021440
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: