Healthcare Provider Details

I. General information

NPI: 1831970227
Provider Name (Legal Business Name): MADISON YATES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MAGNOLIA ST # 4A
GREENSBORO NC
27401-1309
US

IV. Provider business mailing address

1220 MAGNOLIA ST
GREENSBORO NC
27401-1309
US

V. Phone/Fax

Practice location:
  • Phone: 336-663-5700
  • Fax: 336-663-5734
Mailing address:
  • Phone: 336-663-5700
  • Fax: 336-663-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30509
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number700483
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: