Healthcare Provider Details

I. General information

NPI: 1285968438
Provider Name (Legal Business Name): RICHARD W. YEAGER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 GAIL HARRIS ST
ROSWELL NM
88203-8190
US

IV. Provider business mailing address

1200 E GALLINA RD
ROSWELL NM
88201-8927
US

V. Phone/Fax

Practice location:
  • Phone: 575-347-3465
  • Fax:
Mailing address:
  • Phone: 575-347-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00004631
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: