Provider Demographics
NPI:1043221682
Name:YETOLA INC
Entity Type:Organization
Organization Name:YETOLA INC
Other - Org Name:PEACHVIEW DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YETUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEANII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-581-1223
Mailing Address - Street 1:525 FRANKLIN GTWY SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7707
Mailing Address - Country:US
Mailing Address - Phone:678-581-1223
Mailing Address - Fax:678-581-2356
Practice Address - Street 1:525 FRANKLIN GTWY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7707
Practice Address - Country:US
Practice Address - Phone:678-581-1223
Practice Address - Fax:678-581-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 333600000X, 3336L0003X
GAPHRE0085523336I0012X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2014409OtherPK
GA00925097AMedicaid
2014409OtherPK