Healthcare Provider Details

I. General information

NPI: 1003456963
Provider Name (Legal Business Name): JONATHAN YEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ADAM SHEPHERD PKWY
SHEPHERDSVILLE KY
40165-6578
US

IV. Provider business mailing address

111 ASHFORD DR
MT WASHINGTON KY
40047-6206
US

V. Phone/Fax

Practice location:
  • Phone: 502-543-7247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26028568A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number018367
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: