Provider Demographics
NPI:1386605814
Name:HAM, YUTHANA (PHARM D)
Entity type:Individual
Prefix:
First Name:YUTHANA
Middle Name:
Last Name:HAM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 POCKET AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2818
Mailing Address - Country:US
Mailing Address - Phone:209-863-0855
Mailing Address - Fax:
Practice Address - Street 1:1801 H ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1221
Practice Address - Country:US
Practice Address - Phone:209-524-8282
Practice Address - Fax:209-544-0855
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist