Provider Demographics
NPI:1811888217
Name:YAN, SHI NUO CHARISSE (PHARMD)
Entity type:Individual
Prefix:
First Name:SHI NUO CHARISSE
Middle Name:
Last Name:YAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHARISSE
Other - Middle Name:
Other - Last Name:YAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3366
Mailing Address - Country:US
Mailing Address - Phone:608-257-3814
Mailing Address - Fax:
Practice Address - Street 1:15 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3366
Practice Address - Country:US
Practice Address - Phone:608-257-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist