Provider Demographics
NPI:1619730280
Name:YATES, RANDALL (RPH, BCNP)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:YATES
Suffix:
Gender:M
Credentials:RPH, BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 CORSAIR CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7463
Mailing Address - Country:US
Mailing Address - Phone:979-218-2591
Mailing Address - Fax:
Practice Address - Street 1:3111 CORSAIR CIR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7463
Practice Address - Country:US
Practice Address - Phone:979-268-0513
Practice Address - Fax:979-268-0517
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249011835N0905X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear