Provider Demographics
NPI:1124622329
Name:YATES, MANDY (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-6278
Mailing Address - Country:US
Mailing Address - Phone:904-230-6718
Mailing Address - Fax:904-230-6725
Practice Address - Street 1:2680 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-6278
Practice Address - Country:US
Practice Address - Phone:904-230-6718
Practice Address - Fax:904-230-6725
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist