Provider Demographics
NPI:1003191289
Name:TORRES, YOLANDA
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 WATERFORD LAKES DR APT 2218
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7462
Mailing Address - Country:US
Mailing Address - Phone:828-308-7702
Mailing Address - Fax:704-781-0575
Practice Address - Street 1:1876 MAIN ST W
Practice Address - Street 2:
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097-7700
Practice Address - Country:US
Practice Address - Phone:704-781-0574
Practice Address - Fax:704-781-0575
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045978183500000X
NC19512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19512OtherNC STATE LICENSE
NY045978OtherNY STATE