Provider Demographics
NPI:1912244104
Name:AUBOURG, YARDLY
Entity Type:Individual
Prefix:
First Name:YARDLY
Middle Name:
Last Name:AUBOURG
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 1:13210 SW 14TH PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-5721
Mailing Address - Country:US
Mailing Address - Phone:754-422-5751
Mailing Address - Fax:
Practice Address - Street 1:13210 SW 14TH PL
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-5721
Practice Address - Country:US
Practice Address - Phone:754-422-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist