Healthcare Provider Details

I. General information

NPI: 1629443320
Provider Name (Legal Business Name): HANNAH YIM PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 15TH ST APT 18B
FORT LEE NJ
07024-1934
US

IV. Provider business mailing address

1275 15TH ST APT 18B
FORT LEE NJ
07024-1934
US

V. Phone/Fax

Practice location:
  • Phone: 201-788-3342
  • Fax:
Mailing address:
  • Phone: 201-788-3342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03401500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: