Provider Demographics
NPI:1093317554
Name:YAKOUB, MICHAEL A (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:YAKOUB
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 CLARKSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-2810
Mailing Address - Country:US
Mailing Address - Phone:615-244-2795
Mailing Address - Fax:
Practice Address - Street 1:3130 CLARKSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37218-2810
Practice Address - Country:US
Practice Address - Phone:615-244-2795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist