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General NPI Number Information
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NPI Number | 1124161930
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Entity Type | Organization
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Legal Business Name | DANNY B YATES
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 212 W 7TH ST
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City | METROPOLIS
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State | IL
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Zip | 62960-1604
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Country | US
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Telephone | 618-524-9672
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Fax | 618-524-2466
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Provider Business Mailing Address
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Address Line | 212 W 7TH ST
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City | METROPOLIS
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State | IL
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Zip | 62960-1604
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Country | US
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Telephone | 618-524-9672
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Fax | 618-524-2466
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANNY BRUCE YATES
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Credential | PHARMACIST
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Telephone | 618-524-9672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 054.007862
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License Number State | IL
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