Healthcare Provider Details

I. General information

NPI: 1417538844
Provider Name (Legal Business Name): YIFAN HUANG PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 SILAS DEANE HWY
WETHERSFIELD CT
06109-4231
US

IV. Provider business mailing address

1078 SILAS DEANE HWY
WETHERSFIELD CT
06109-4231
US

V. Phone/Fax

Practice location:
  • Phone: 860-529-2535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0015317
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: