Healthcare Provider Details

I. General information

NPI: 1891058160
Provider Name (Legal Business Name): YEE WAH FONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 BRIDGEPORT WAY SW
LAKEWOOD WA
98499-3004
US

IV. Provider business mailing address

5422 52ND AVENUE CT W
UNIVERSITY PLACE WA
98467-4810
US

V. Phone/Fax

Practice location:
  • Phone: 253-985-6860
  • Fax:
Mailing address:
  • Phone: 808-382-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00070601
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: