Provider Demographics
NPI:1578854535
Name:YELTON, CHARLES P (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:YELTON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-7413
Mailing Address - Country:US
Mailing Address - Phone:606-632-1936
Mailing Address - Fax:606-632-9812
Practice Address - Street 1:2300 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7413
Practice Address - Country:US
Practice Address - Phone:606-632-1936
Practice Address - Fax:606-632-9812
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist