Provider Demographics
NPI:1891386025
Name:YATES, AMANDA (RPH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:YATES
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 1:248 SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-9249
Mailing Address - Country:US
Mailing Address - Phone:601-665-5970
Mailing Address - Fax:
Practice Address - Street 1:248 SUNDANCE CIR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-9249
Practice Address - Country:US
Practice Address - Phone:601-665-5970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-09032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist