Provider Demographics
NPI:1477165033
Name:GREENWELL, YVETTE R (RPH)
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:R
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:R
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2318 FREDERICA ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4826
Mailing Address - Country:US
Mailing Address - Phone:270-686-7873
Mailing Address - Fax:270-686-7864
Practice Address - Street 1:2318 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4826
Practice Address - Country:US
Practice Address - Phone:757-386-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist