Healthcare Provider Details

I. General information

NPI: 1528497534
Provider Name (Legal Business Name): ELIZABETH YETTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 LIBRARY CT
OREGON CITY OR
97045-4041
US

IV. Provider business mailing address

4508 AUBURN WAY N STE A-104
AUBURN WA
98002-1381
US

V. Phone/Fax

Practice location:
  • Phone: 503-557-3051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0013868
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.296606
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60437042
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: