Provider Demographics
NPI:1306080288
Name:YEE, PHONGSIRI SIVASEN (RPH)
Entity type:Individual
Prefix:MRS
First Name:PHONGSIRI
Middle Name:SIVASEN
Last Name:YEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 COPELAND SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19830-1828
Mailing Address - Country:US
Mailing Address - Phone:610-872-4346
Mailing Address - Fax:610-872-4574
Practice Address - Street 1:5005 EDGEMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-1202
Practice Address - Country:US
Practice Address - Phone:610-872-4346
Practice Address - Fax:610-872-4574
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DERP045015R183500000X
DEA1-0003250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP045015ROtherPHARMACY LICENSE
DEA1-0003250OtherPHARMACY LICENSE