MEDICARE: MR. PHILLIP YOO PHARM. D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	49241	TX

General Provider Information

NPI Number	:	1386921393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILLIP YOO PHARM. D

Provider Business Mailing Address
First Line	:	1702 FM 3036 APT 6106
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-7845
Country	:	US
Telephone Number	:	361-537-8727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2509
Country	:	US
Telephone Number	:	361-552-7451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2011
Last Update Date	:	11/04/2011

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