Basic Information
| Provider Information | |||||||||
| NPI: | 1194278333 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YE | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | WEILAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3007 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981143007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065332723 | ||||||||
| FaxNumber: | 2066525216 | ||||||||
| Practice Location | |||||||||
| Address1: | 16549 AURORA AVE N | ||||||||
| Address2: | |||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981335308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065332723 | ||||||||
| FaxNumber: | 2066525216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2016 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 18512-40 | WI | N | Pharmacy Service Providers | Pharmacist | 183500000X | PH60779386 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.