Basic Information
| Provider Information | |||||||||
| NPI: | 1356348668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YALE | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1708 BOULDER DR | ||||||||
| Address2: | |||||||||
| City: | GALLUP | ||||||||
| State: | NM | ||||||||
| PostalCode: | 873015703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057223117 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 516 NIZHONI BLVD | ||||||||
| Address2: | |||||||||
| City: | GALLUP | ||||||||
| State: | NM | ||||||||
| PostalCode: | 873015748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057221185 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 11552 | OK | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P1200X | 6731 | NM | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P0018X | 131 | NM | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.