Healthcare Provider Details

I. General information

NPI: 1619015666
Provider Name (Legal Business Name): KIYO YODA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

IV. Provider business mailing address

121 BIRCHWOOD DR
WEST CHESTER PA
19380-7324
US

V. Phone/Fax

Practice location:
  • Phone: 610-648-1172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP438342
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: