Provider Demographics
NPI:1093203564
Name:CHOATE, MICHAEL A (BS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:CHOATE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:ALLARDT
Mailing Address - State:TN
Mailing Address - Zip Code:38504-0442
Mailing Address - Country:US
Mailing Address - Phone:931-267-8871
Mailing Address - Fax:
Practice Address - Street 1:539 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-4105
Practice Address - Country:US
Practice Address - Phone:931-879-4887
Practice Address - Fax:931-879-4898
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61851835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care