Provider Demographics
NPI:1518554872
Name:YATES, LORI (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CANVASBACK CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-5608
Mailing Address - Country:US
Mailing Address - Phone:870-321-6642
Mailing Address - Fax:
Practice Address - Street 1:2089 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-7656
Practice Address - Country:US
Practice Address - Phone:870-508-0054
Practice Address - Fax:870-508-0060
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR08883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist