Provider Demographics
NPI:1568951127
Name:YELLAND, JERAD M (PHARMD)
Entity Type:Individual
Prefix:
First Name:JERAD
Middle Name:M
Last Name:YELLAND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BLUEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5093
Mailing Address - Country:US
Mailing Address - Phone:785-776-4841
Mailing Address - Fax:785-776-4842
Practice Address - Street 1:101 BLUEMONT AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5093
Practice Address - Country:US
Practice Address - Phone:785-776-4841
Practice Address - Fax:785-776-4842
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014634183500000X
KS1-16607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist