Provider Demographics
NPI:1306082813
Name:YU, KYONG IL (RPH)
Entity type:Individual
Prefix:
First Name:KYONG IL
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 EHRET AVE
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640
Mailing Address - Country:US
Mailing Address - Phone:646-996-9503
Mailing Address - Fax:
Practice Address - Street 1:1400 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:FORTLEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4405
Practice Address - Country:US
Practice Address - Phone:201-224-8877
Practice Address - Fax:201-224-8871
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045031183500000X
NJ28RI03343800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist