Healthcare Provider Details

I. General information

NPI: 1053690073
Provider Name (Legal Business Name): FREDDIE YEUNG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 W ENNIS AVE
ENNIS TX
75119-3806
US

IV. Provider business mailing address

606 W ENNIS AVE
ENNIS TX
75119-3806
US

V. Phone/Fax

Practice location:
  • Phone: 972-875-5996
  • Fax:
Mailing address:
  • Phone: 972-875-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50324
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: