Provider Demographics
NPI:1003664905
Name:KOLTA, YVETTE G
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:G
Last Name:KOLTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 COLUMBIA RD APT 347
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3554
Mailing Address - Country:US
Mailing Address - Phone:703-687-8286
Mailing Address - Fax:
Practice Address - Street 1:5250 COLUMBIA RD APT 347
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3554
Practice Address - Country:US
Practice Address - Phone:703-687-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03444022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist