Provider Demographics
NPI:1396037156
Name:YANCEY, KATHYRN ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:KATHYRN
Middle Name:ANNE
Last Name:YANCEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-1468
Mailing Address - Country:US
Mailing Address - Phone:704-867-1265
Mailing Address - Fax:704-864-8742
Practice Address - Street 1:1850 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-1468
Practice Address - Country:US
Practice Address - Phone:704-867-1265
Practice Address - Fax:704-864-8742
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist