Healthcare Provider Details

I. General information

NPI: 1992857593
Provider Name (Legal Business Name): GREG YEAKEL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ISU THOMAS B. THIELEN STUDENT HEALTH CENTER UNION & SHELDON DR
AMES IA
50011-2260
US

IV. Provider business mailing address

ISU THOMAS B. THIELEN STUDENT HEALTH CENTER UNION & SHELDON DR
AMES IA
50011-2260
US

V. Phone/Fax

Practice location:
  • Phone: 515-294-5801
  • Fax: 515-294-7180
Mailing address:
  • Phone: 515-294-5801
  • Fax: 515-294-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14684
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: