Healthcare Provider Details

I. General information

NPI: 1326804485
Provider Name (Legal Business Name): JACK T YEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 LAUREL BROOK LN
FAIRFIELD CT
06824-2079
US

IV. Provider business mailing address

96 LAUREL BROOK LN
FAIRFIELD CT
06824-2079
US

V. Phone/Fax

Practice location:
  • Phone: 646-573-6168
  • Fax:
Mailing address:
  • Phone: 646-573-6168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0010371
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0010371
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: