Healthcare Provider Details

I. General information

NPI: 1174846174
Provider Name (Legal Business Name): MICHELLE A YIM PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 KINGS HWY
BROOKLYN NY
11229-1208
US

IV. Provider business mailing address

1720 KINGS HWY
BROOKLYN NY
11229-1208
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-3377
  • Fax:
Mailing address:
  • Phone: 718-998-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053899
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: