Provider Demographics
NPI:1760583371
Name:ALLEN, YOLANDA M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:M
Last Name:ALLEN
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 1:8191 BRYCE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0473
Mailing Address - Country:US
Mailing Address - Phone:801-255-7507
Mailing Address - Fax:
Practice Address - Street 1:6525 S STATE ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7218
Practice Address - Country:US
Practice Address - Phone:801-743-6476
Practice Address - Fax:801-743-6477
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT142271OtherPHARMACIST LICENSE NUMBE