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General NPI Number Information
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NPI Number | 1699846618
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Entity Type | Organization
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Legal Business Name | YW PROFESSIONAL AND PFC TRADING ALLIANCE INC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 5150 BUFORD HWY NE STE B180
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City | DORAVILLE
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State | GA
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Zip | 30340-1153
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Country | US
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Telephone | 770-455-8882
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Fax | 770-455-8806
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Provider Business Mailing Address
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Address Line | 5150 BUFORD HWY NE STE B180
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City | DORAVILLE
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State | GA
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Zip | 30340-1153
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Country | US
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Telephone | 770-455-8882
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Fax | 770-455-8806
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Authorized Official
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Title or Position | GEN MGR
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Name | ALEC CHAN
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Credential | RPH
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Telephone | 770-455-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE007868
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License Number State | GA
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