Provider Demographics
NPI:1457488819
Name:YODER, LAMAR J
Entity Type:Individual
Prefix:
First Name:LAMAR
Middle Name:J
Last Name:YODER
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 1:123 S FULTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1351
Mailing Address - Country:US
Mailing Address - Phone:419-335-6901
Mailing Address - Fax:419-335-6901
Practice Address - Street 1:123 S FULTON ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1351
Practice Address - Country:US
Practice Address - Phone:419-335-6901
Practice Address - Fax:419-335-6901
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03108658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6620802Medicaid
OH0398160001Medicaid