Provider Demographics
NPI:1104201169
Name:YATES, ZACHERY
Entity Type:Individual
Prefix:
First Name:ZACHERY
Middle Name:
Last Name:YATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6437 MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-7209
Mailing Address - Country:US
Mailing Address - Phone:315-838-0600
Mailing Address - Fax:
Practice Address - Street 1:6437 MONUMENT RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-7209
Practice Address - Country:US
Practice Address - Phone:315-838-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist