Provider Demographics
NPI:1629351663
Name:YAGER, KIMBERLY JILL (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JILL
Last Name:YAGER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-1131
Mailing Address - Country:US
Mailing Address - Phone:618-395-4511
Mailing Address - Fax:
Practice Address - Street 1:2006 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4914
Practice Address - Country:US
Practice Address - Phone:618-553-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist