Provider Demographics
NPI:1477637395
Name:TENNEY, YVONNE KAY (RPH)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:KAY
Last Name:TENNEY
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 1:720 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-1435
Mailing Address - Country:US
Mailing Address - Phone:304-592-2680
Mailing Address - Fax:304-592-2684
Practice Address - Street 1:720 PIKE ST
Practice Address - Street 2:
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-1435
Practice Address - Country:US
Practice Address - Phone:304-592-2680
Practice Address - Fax:304-592-2684
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6003088000Medicaid
WV6003088000Medicaid