Provider Demographics
NPI:1194007799
Name:YATES, CRAIG A (RPH)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:YATES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-1762
Mailing Address - Country:US
Mailing Address - Phone:309-827-3069
Mailing Address - Fax:309-827-5881
Practice Address - Street 1:1408 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-1762
Practice Address - Country:US
Practice Address - Phone:309-827-3069
Practice Address - Fax:309-827-5881
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-040489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist