Provider Demographics
NPI:1427050905
Name:YAN, ALICE
Entity type:Individual
Prefix:MISS
First Name:ALICE
Middle Name:
Last Name:YAN
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 1:102 MOTT ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5600
Mailing Address - Country:US
Mailing Address - Phone:212-732-3388
Mailing Address - Fax:212-732-3337
Practice Address - Street 1:102 MOTT ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5600
Practice Address - Country:US
Practice Address - Phone:212-732-3388
Practice Address - Fax:212-732-3337
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist