Provider Demographics
NPI:1851390405
Name:YATES CENTER PHARMACY, INC
Entity Type:Organization
Organization Name:YATES CENTER PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEDLACEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-625-2221
Mailing Address - Street 1:122 W RUTLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:YATES CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66783-1238
Mailing Address - Country:US
Mailing Address - Phone:620-625-2221
Mailing Address - Fax:620-625-2453
Practice Address - Street 1:122 W RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:YATES CENTER
Practice Address - State:KS
Practice Address - Zip Code:66783-1238
Practice Address - Country:US
Practice Address - Phone:620-625-2221
Practice Address - Fax:620-625-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-16
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS208078183500000X, 333600000X
KS0193610001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100439000AMedicaid
KS100439000BMedicaid
KS1851390405Medicare NSC