Active NPI
Lucky Yang
- Pharmacist
- Brockton, MA
National Provider Identifier
1053540062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 24903
- Practice address
- 1933 Main St
Brockton, MA 02301-7131 - Phone
- (508) 587-0235
- Fax
- (508) 584-0874
- NPI assigned
- Jul 11, 2009
- Last updated
- Jul 24, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 122629 | MN | |
| Pharmacist | 183500000X | 24903 | MA | Primary |
Addresses
Primary practice location
1933 Main St
Brockton, MA 02301-7131
Mailing address
4152 Lakeland Ave N
Robbinsdale, MN 55422-1832
Phone (763) 535-2459
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24903 | MA | MD | Pharmacist |
| 122629 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| Grand St Paul CVS LLC | Past | Accepting new patients | |
| Grand St Paul CVS LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658620800000",
"number": "1053540062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4152 LAKELAND AVE N",
"city": "ROBBINSDALE",
"state": "MN",
"postal_code": "554221832",
"telephone_number": "763-535-2459",
"fax_number": "763-535-6063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1933 MAIN ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023017131",
"telephone_number": "508-587-0235",
"fax_number": "508-584-0874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YANG",
"first_name": "LUCKY",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-11",
"last_updated": "2022-07-24",
"certification_date": "2022-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "122629",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "24903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.