Provider Demographics
NPI:1467889352
Name:TYLE, LLC
Entity Type:Organization
Organization Name:TYLE, LLC
Other - Org Name:RYALS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:YAWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:229-318-9991
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MC RAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055-0209
Mailing Address - Country:US
Mailing Address - Phone:229-868-6735
Mailing Address - Fax:229-868-2611
Practice Address - Street 1:12 S SECOND AVE
Practice Address - Street 2:
Practice Address - City:MC RAE
Practice Address - State:GA
Practice Address - Zip Code:31055-4659
Practice Address - Country:US
Practice Address - Phone:229-868-6735
Practice Address - Fax:229-868-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE009962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000035395AMedicaid
GA000035395AMedicaid