MEDICARE: ELLEN YI PHARMD, RPH, MBA

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	072425	NY

General Provider Information

NPI Number	:	1629889167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN YI PHARMD, RPH, MBA

Provider Business Mailing Address
First Line	:	3717 UNION ST FL 3
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-4159
Country	:	US
Telephone Number	:	646-420-1539
Fax Number	:

Provider Business Practice Location Address
First Line	:	3A BOND ST
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-2408
Country	:	US
Telephone Number	:	516-304-5893
Fax Number	:

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

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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