Provider Demographics
NPI:1083218564
Name:YOTHER, JEFFREY BURKE JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BURKE
Last Name:YOTHER
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 ACTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6205
Mailing Address - Country:US
Mailing Address - Phone:256-390-8314
Mailing Address - Fax:
Practice Address - Street 1:2608 W MEIGHAN BLVD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-1714
Practice Address - Country:US
Practice Address - Phone:256-543-9709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist