Healthcare Provider Details

I. General information

NPI: 1063715233
Provider Name (Legal Business Name): BENNY YIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 S HOGAN DR
LORAIN OH
44053-1416
US

IV. Provider business mailing address

3711 S HOGAN DR
LORAIN OH
44053-1416
US

V. Phone/Fax

Practice location:
  • Phone: 440-522-9903
  • Fax:
Mailing address:
  • Phone: 440-522-9903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number06006676
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: