Healthcare Provider Details

I. General information

NPI: 1871971713
Provider Name (Legal Business Name): WARREN HAMILTON YEAGER JR. R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 PARK MEADOWS WAY
GLEN ALLEN VA
23059-2545
US

IV. Provider business mailing address

509 PARK MEADOWS WAY
GLEN ALLEN VA
23059-2545
US

V. Phone/Fax

Practice location:
  • Phone: 484-798-8138
  • Fax:
Mailing address:
  • Phone: 484-798-8138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202210380
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: