Healthcare Provider Details

I. General information

NPI: 1396926218
Provider Name (Legal Business Name): THERESA K YEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9602 ROCKAWAY BLVD
OZONE PARK NY
11417-1613
US

IV. Provider business mailing address

16529 UNION TPKE 1 FL
FLUSHING NY
11366-1238
US

V. Phone/Fax

Practice location:
  • Phone: 718-848-2334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: