Provider Demographics
NPI:1598081994
Name:YVONNE ENTERPRISES
Entity Type:Organization
Organization Name:YVONNE ENTERPRISES
Other - Org Name:KAY PHARMACY #003
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-762-3701
Mailing Address - Street 1:637 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3604
Mailing Address - Country:US
Mailing Address - Phone:863-268-8218
Mailing Address - Fax:863-875-5628
Practice Address - Street 1:637 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3604
Practice Address - Country:US
Practice Address - Phone:863-268-8218
Practice Address - Fax:863-875-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH266583336C0003X, 3336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008929200Medicaid
2139801OtherPK