Healthcare Provider Details

I. General information

NPI: 1548906886
Provider Name (Legal Business Name): AUDREY YEITER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24416 N 19TH AVE
PHOENIX AZ
85085-1887
US

IV. Provider business mailing address

24416 N 19TH AVE
PHOENIX AZ
85085-1887
US

V. Phone/Fax

Practice location:
  • Phone: 855-293-8950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS025385
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: