Provider Demographics
NPI:1629889167
Name:YI, ELLEN (PHARMD, RPH, MBA)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:PHARMD, RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 UNION ST FL 3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4159
Mailing Address - Country:US
Mailing Address - Phone:646-420-1539
Mailing Address - Fax:
Practice Address - Street 1:3A BOND ST
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2408
Practice Address - Country:US
Practice Address - Phone:516-304-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist