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General NPI Number Information
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NPI Number | 1568906352
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Entity Type | Individual
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Provider Name | YEHENEW B. YESHIWAS
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Gender | Male
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 23500 KASSON ROAD
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City | TRACY
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State | CA
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Zip | 95378
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Country | US
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Telephone | 209-835-4141
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Fax | 209-830-3807
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Provider Business Mailing Address
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Address Line | 426 CYPRESS AVE
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City | SAN JOSE
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State | CA
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Zip | 95117-1529
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Country | US
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Telephone | 408-250-2570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 59364
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License Number State | CA
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