Provider Demographics
NPI:1386921393
Name:YOO, PHILLIP (PHARM D)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:YOO
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 1:1702 FM 3036 APT 6106
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-7845
Mailing Address - Country:US
Mailing Address - Phone:361-537-8727
Mailing Address - Fax:
Practice Address - Street 1:1302 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2509
Practice Address - Country:US
Practice Address - Phone:361-552-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist