Healthcare Provider Details

I. General information

NPI: 1386102861
Provider Name (Legal Business Name): YU CHEUNG POON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 NACHES AVE SW
RENTON WA
98057-2617
US

IV. Provider business mailing address

315 158TH PL SE
BELLEVUE WA
98008-4649
US

V. Phone/Fax

Practice location:
  • Phone: 206-630-1330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00039757
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: