=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740615491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YATES PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2013
-----------------------------------------------------
Last Update Date | 11/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 432 HOPKINSVILLE RD
-----------------------------------------------------
City | RUSSELLVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42276-1284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-726-8451
-----------------------------------------------------
Fax | 270-726-8696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 432 HOPKINSVILLE RD
-----------------------------------------------------
City | RUSSELLVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42276-1284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-726-8451
-----------------------------------------------------
Fax | 270-726-8696
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | SCOTT YATES
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 270-726-8451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | P07597
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------