Healthcare Provider Details

I. General information

NPI: 1043443294
Provider Name (Legal Business Name): NICOLE YEAGER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 AIRPORT CENTER DR
ALLENTOWN PA
18109
US

IV. Provider business mailing address

912 AIRPORT CENTER DR
ALLENTOWN PA
18109
US

V. Phone/Fax

Practice location:
  • Phone: 610-573-5711
  • Fax: 610-573-5711
Mailing address:
  • Phone: 610-573-5711
  • Fax: 610-573-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP041766L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: