Healthcare Provider Details

I. General information

NPI: 1922834035
Provider Name (Legal Business Name): HARRISON YOO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GOFF MOUNTAIN RD
CROSS LANES WV
25313-1410
US

IV. Provider business mailing address

161 PRESIDIO POINTE
CHARLESTON WV
25313-1591
US

V. Phone/Fax

Practice location:
  • Phone: 304-769-0590
  • Fax:
Mailing address:
  • Phone: 520-250-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0014390
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: