Healthcare Provider Details

I. General information

NPI: 1265367635
Provider Name (Legal Business Name): YAMANNAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 S KANAWHA ST STE 104
BECKLEY WV
25801-5507
US

IV. Provider business mailing address

54 OSPREY RD
BECKLEY WV
25801-3684
US

V. Phone/Fax

Practice location:
  • Phone: 304-673-6256
  • Fax:
Mailing address:
  • Phone: 304-673-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. SEHRA PATHAN
Title or Position: MEMBER
Credential:
Phone: 304-673-6256