Provider Demographics
NPI:1871903559
Name:YANCY, CONSUELA (RPH)
Entity type:Individual
Prefix:
First Name:CONSUELA
Middle Name:
Last Name:YANCY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16203 BOOT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-4745
Mailing Address - Country:US
Mailing Address - Phone:713-515-9036
Mailing Address - Fax:
Practice Address - Street 1:16203 BOOT RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-4745
Practice Address - Country:US
Practice Address - Phone:713-515-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist