=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912879727
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY YANG PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2025
-----------------------------------------------------
Last Update Date | 09/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3650 VICTORIA ST N
-----------------------------------------------------
City | SHOREVIEW
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55126-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-777-2312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6408 FLORIDA AVE N
-----------------------------------------------------
City | BROOKLYN PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55428-2524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-777-2312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 127110
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------