=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740870237
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FABIO HUANG YE PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2021
-----------------------------------------------------
Last Update Date | 08/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1095 HWY 95
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89415-7771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-945-2159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6020 KINGSMILL TER
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94568-7462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-493-8555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH-0018233
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 20787
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------