Provider Demographics
NPI:1619334364
Name:YU, KEVIN (RPH)
Entity type:Individual
Prefix:MR
First Name:KEVIN
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 1:13384 MOSSVINE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0570
Mailing Address - Country:US
Mailing Address - Phone:214-675-0167
Mailing Address - Fax:
Practice Address - Street 1:13384 MOSSVINE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0570
Practice Address - Country:US
Practice Address - Phone:214-675-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14825183500000X
ORRPH-0014979183500000X
TN38979183500000X
VA0202214333183500000X
WVRP0009207183500000X
TX38290183500000X
AL18629183500000X
ARPD13178183500000X
KY018104183500000X
LAPST.020971183500000X
MI5302043373183500000X
MST-13868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist