Provider Demographics
NPI:1962506162
Name:YATES CENTER DRUG INC
Entity Type:Organization
Organization Name:YATES CENTER DRUG INC
Other - Org Name:YATES CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
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:2006-09-11
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100439000AMedicaid
KS100439000BMedicaid
KS1851390405OtherNPI DME DEPARTMENT
KS051143OtherBCBS DRUG
KS1713444OtherNCPDP
KS010390OtherBCBS DME
KS100439000AMedicaid
KS1713444OtherNCPDP