Provider Demographics
NPI:1649517210
Name:STARK, YVONNE A (RPH)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:A
Last Name:STARK
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 1:11957 W 75TH LN
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-5307
Mailing Address - Country:US
Mailing Address - Phone:303-807-6321
Mailing Address - Fax:
Practice Address - Street 1:12450 E ARAPAHOE RD
Practice Address - Street 2:SUITE A1
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3971
Practice Address - Country:US
Practice Address - Phone:303-799-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA-10984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist