Healthcare Provider Details

I. General information

NPI: 1629351663
Provider Name (Legal Business Name): KIMBERLY JILL YAGER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 02/03/2021
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 MAGNOLIA ST
EFFINGHAM IL
62401-4914
US

IV. Provider business mailing address

914 W MAIN ST
OLNEY IL
62450-1131
US

V. Phone/Fax

Practice location:
  • Phone: 618-553-0631
  • Fax:
Mailing address:
  • Phone: 618-395-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.289520
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: