Provider Demographics
NPI:1639400344
Name:BUDOMO, YOLANDA ARCIAGA
Entity type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:ARCIAGA
Last Name:BUDOMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:ARCIAGA
Other - Last Name:BUDOMO-FOWLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3487 STOCKTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3681
Mailing Address - Country:US
Mailing Address - Phone:928-692-1822
Mailing Address - Fax:928-692-6404
Practice Address - Street 1:2116 ROY ROGERS WAY
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0945
Practice Address - Country:US
Practice Address - Phone:928-692-4743
Practice Address - Fax:928-692-6404
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist