Provider Demographics
NPI:1609178649
Name:KING, YVETTE ANITA (PHARMD/MPH)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:ANITA
Last Name:KING
Suffix:
Gender:F
Credentials:PHARMD/MPH
Other - Prefix:DR
Other - First Name:YVETTE
Other - Middle Name:ANITA
Other - Last Name:KING-KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD/MPH
Mailing Address - Street 1:1305 GAUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3015
Mailing Address - Country:US
Mailing Address - Phone:985-641-2550
Mailing Address - Fax:
Practice Address - Street 1:1638 CHANCER LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4537
Practice Address - Country:US
Practice Address - Phone:757-206-7452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017635183500000X
VA0202011990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist