Provider Demographics
NPI:1881851327
Name:YEARSLEY, KEVIN NATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:NATHAN
Last Name:YEARSLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1756
Mailing Address - Country:US
Mailing Address - Phone:208-436-1200
Mailing Address - Fax:208-436-6121
Practice Address - Street 1:310 ONEIDA ST
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1756
Practice Address - Country:US
Practice Address - Phone:208-436-1200
Practice Address - Fax:208-436-6121
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist