Active NPI
Shirley Yan Wah Yu
- Pharmacist
- Waltham, MA
National Provider Identifier
1982206652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH236364
- Practice address
- 55 Russell St
Waltham, MA 02453-8517 - Phone
- (781) 642-7416
- NPI assigned
- Nov 9, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH236364 | MA | Primary |
Addresses
Primary practice location
55 Russell St
Waltham, MA 02453-8517
Mailing address
170 Clocktower Dr Unit 5408
Waltham, MA 02452-7882
Phone (617) 849-0347
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 |
|---|---|---|---|
| PH236364 | MA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Victory Distributors LLC | Past | Accepting new patients | |
| Victory Distributors LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Leominster, MA
- NPI 1346358728
-
- Community/Retail Pharmacy
- Waltham, MA
- NPI 1568647527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604880000000",
"number": "1982206652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "170 CLOCKTOWER DR UNIT 5408",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024527882",
"telephone_number": "617-849-0347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 RUSSELL ST",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024538517",
"telephone_number": "781-642-7416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YU",
"first_name": "SHIRLEY",
"middle_name": "YAN WAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-09",
"last_updated": "2020-11-09",
"certification_date": "2020-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH236364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.