Healthcare Provider Details

I. General information

NPI: 1780856773
Provider Name (Legal Business Name): JOHN STEVEN YASKANICH JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN STEVEN YASKANICH JR. RPH

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N HWY 491 NORTHERN NAVAJO MEDICAL CENTER OUTPATIENT PHARMACY
SHIPROCK NM
87420-0160
US

IV. Provider business mailing address

2227 TUCKER LANE
CORTEZ CO
81321-2600
US

V. Phone/Fax

Practice location:
  • Phone: 970-570-6867
  • Fax:
Mailing address:
  • Phone: 970-570-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03311655
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: