Provider Demographics
NPI:1104137587
Name:YU, MARY ROCHELLE
Entity type:Individual
Prefix:
First Name:MARY ROCHELLE
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13550 PAXTON ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2352
Mailing Address - Country:US
Mailing Address - Phone:818-272-2709
Mailing Address - Fax:818-272-2706
Practice Address - Street 1:13550 PAXTON ST
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2352
Practice Address - Country:US
Practice Address - Phone:818-272-2709
Practice Address - Fax:818-272-2706
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist