Organization
MICHAEL YARWORTH
Active
Other names
MIKES PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL YARWORTH DPH (OWNER AND CHIEF PHARMACIST)
(931) 592-9190
Entity
Organization
Contact information
Practice address
740 MAIN ST, TRACY CITY, TN 37387
(931) 592-9190
(931) 592-9203
Mailing address
PO BOX 669, TRACY CITY, TN 37387-0669
(931) 592-9190
(931) 592-9203
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
130
TN
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0325290001
MEDICARE
TN
05
—
1730259722
—
TN
01
—
2088655
PK
—
Enumeration date
11/08/2006
Last updated
12/01/2021
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