Healthcare Provider Details

I. General information

NPI: 1609417344
Provider Name (Legal Business Name): YUTING JIANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6731 WOODLAND AVE
PHILADELPHIA PA
19142-1602
US

IV. Provider business mailing address

2050 ROBBINS AVE
PHILADELPHIA PA
19149-2921
US

V. Phone/Fax

Practice location:
  • Phone: 215-724-9677
  • Fax:
Mailing address:
  • Phone: 267-306-7086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452265
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: