Healthcare Provider Details

I. General information

NPI: 1881671170
Provider Name (Legal Business Name): ROGER K YABU RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 REID ST
TACOMA WA
98431-1100
US

IV. Provider business mailing address

31504 36TH AVE SW
FEDERAL WAY WA
98023-2104
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1950
  • Fax:
Mailing address:
  • Phone: 253-874-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00011663
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: