Provider Demographics
NPI:1902373244
Name:YANG, JEFFREY XACHAO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:XACHAO
Last Name:YANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 FASHION WAY
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-4952
Mailing Address - Country:US
Mailing Address - Phone:951-660-6378
Mailing Address - Fax:
Practice Address - Street 1:806 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-4478
Practice Address - Country:US
Practice Address - Phone:951-849-8614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist