Provider Demographics
NPI:1487934196
Name:BROTHERTON, YATES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:YATES
Middle Name:
Last Name:BROTHERTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-4343
Mailing Address - Country:US
Mailing Address - Phone:515-971-5951
Mailing Address - Fax:
Practice Address - Street 1:1215 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-4343
Practice Address - Country:US
Practice Address - Phone:319-524-0145
Practice Address - Fax:319-524-0168
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist