Healthcare Provider Details

I. General information

NPI: 1962806133
Provider Name (Legal Business Name): JUSTIN YEE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 06/15/2015
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

11315 BRIDGEPORT WAY SW
LAKEWOOD WA
98499-3004
US

V. Phone/Fax

Practice location:
  • Phone: 253-985-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03232949-2
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60289613
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: