Provider Demographics
NPI:1043527534
Name:YDS PHARMACY CORPORATION
Entity type:Organization
Organization Name:YDS PHARMACY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-843-7200
Mailing Address - Street 1:12370 HESPERIA RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7719
Mailing Address - Country:US
Mailing Address - Phone:760-843-7200
Mailing Address - Fax:760-843-7360
Practice Address - Street 1:12370 HESPERIA RD STE 7
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4787
Practice Address - Country:US
Practice Address - Phone:760-843-7200
Practice Address - Fax:760-843-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY504253336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5639200OtherNCPDP PROVIDER IDENTIFICATION NUMBER