Provider Demographics
NPI:1932451473
Name:YODER, KATRINA A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:A
Last Name:YODER
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 1:58165 GOLDENROD TRL
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-6259
Mailing Address - Country:US
Mailing Address - Phone:574-848-0660
Mailing Address - Fax:574-848-0663
Practice Address - Street 1:300 E ELKHART ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:IN
Practice Address - Zip Code:46507-9205
Practice Address - Country:US
Practice Address - Phone:574-848-0660
Practice Address - Fax:574-848-0663
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020466A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist