Healthcare Provider Details

I. General information

NPI: 1790764322
Provider Name (Legal Business Name): DAVID ROLAND YOAKUM JR. PHARMD, CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 MEDICAL CENTER DR
RAINELLE WV
25962-1064
US

IV. Provider business mailing address

176 MEDICAL CENTER DR
RAINELLE WV
25962-1064
US

V. Phone/Fax

Practice location:
  • Phone: 304-438-6186
  • Fax: 304-438-6185
Mailing address:
  • Phone: 304-438-6186
  • Fax: 304-438-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5967
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: