Provider Demographics
NPI:1740615491
Name:YATES PHARMACY LLC
Entity Type:Organization
Organization Name:YATES PHARMACY LLC
Other - Org Name:YATES PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-726-8451
Mailing Address - Street 1:432 HOPKINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-1284
Mailing Address - Country:US
Mailing Address - Phone:270-726-8451
Mailing Address - Fax:270-726-8696
Practice Address - Street 1:432 HOPKINSVILLE RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1284
Practice Address - Country:US
Practice Address - Phone:270-726-8451
Practice Address - Fax:270-726-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP075973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100262540Medicaid
2142884OtherPK
KY7100262540Medicaid