Provider Demographics
NPI:1164779914
Name:YATES, LEIGH
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12917 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-9448
Mailing Address - Country:US
Mailing Address - Phone:937-763-3398
Mailing Address - Fax:
Practice Address - Street 1:1470 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-4101
Practice Address - Country:US
Practice Address - Phone:740-773-8402
Practice Address - Fax:740-779-0598
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist