Individual
MR. TIMOTHY L YANTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
890 CHETCO AVENUE, BROOKINGS, OR 97415
(541) 469-2616
(541) 412-0744
Mailing address
890 CHETCO AVENUE, P. O. 547, BROOKINGS, OR 97415
(541) 469-2616
(541) 412-0744
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH00006858
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033357
—
OR
01
—
3801126
NCPDP
OR
Enumeration date
06/08/2006
Last updated
07/08/2007
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