Provider Demographics
NPI:1861985905
Name:YERED, LOUIS JOSEPH JR
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:JOSEPH
Last Name:YERED
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W HARVARD BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-3874
Mailing Address - Country:US
Mailing Address - Phone:805-525-3315
Mailing Address - Fax:805-933-3706
Practice Address - Street 1:110 W HARVARD BLVD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060
Practice Address - Country:US
Practice Address - Phone:805-525-3315
Practice Address - Fax:805-933-3706
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH37006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist