Healthcare Provider Details

I. General information

NPI: 1255817771
Provider Name (Legal Business Name): KIMBERLY LATHAM YETZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 HIGHWAY 431 S
OWENS CROSS ROADS AL
35763-9204
US

IV. Provider business mailing address

7100 BAREFOOT CIR SE
OWENS CROSS ROADS AL
35763-8710
US

V. Phone/Fax

Practice location:
  • Phone: 256-512-5679
  • Fax:
Mailing address:
  • Phone: 256-508-5298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14702
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: