Provider Demographics
NPI:1326352030
Name:YATES, JEFFERY BRADFORD (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:BRADFORD
Last Name:YATES
Suffix:
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 1:2201 NE 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4147
Mailing Address - Country:US
Mailing Address - Phone:503-949-4325
Mailing Address - Fax:
Practice Address - Street 1:1555 NE DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-4271
Practice Address - Country:US
Practice Address - Phone:503-666-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI-0010493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist