Provider Demographics
NPI:1558700609
Name:LOCKHART, YANCEY EVAN (PHARMD MSBA)
Entity Type:Individual
Prefix:DR
First Name:YANCEY
Middle Name:EVAN
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:PHARMD MSBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 WILSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-3320
Mailing Address - Country:US
Mailing Address - Phone:540-320-8771
Mailing Address - Fax:
Practice Address - Street 1:7373 PEPPERS FERRY BLVD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:VA
Practice Address - Zip Code:24141-8857
Practice Address - Country:US
Practice Address - Phone:540-731-4033
Practice Address - Fax:540-731-4038
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202212127OtherVIRGINIA PHARMACIST LICENSE