Provider Demographics
NPI:1174705651
Name:YOON, MICHAEL C (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:YOON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 S TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5506
Mailing Address - Country:US
Mailing Address - Phone:716-433-3377
Mailing Address - Fax:716-433-2512
Practice Address - Street 1:459 S TRANSIT RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5506
Practice Address - Country:US
Practice Address - Phone:716-433-3377
Practice Address - Fax:716-433-2512
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00986883Medicaid