Provider Demographics
NPI:1598400640
Name:TYREE, RELLAMICHELLE
Entity Type:Individual
Prefix:
First Name:RELLAMICHELLE
Middle Name:
Last Name:TYREE
Suffix:
Gender:F
Credentials:
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 882
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30081-0882
Mailing Address - Country:US
Mailing Address - Phone:770-826-4981
Mailing Address - Fax:
Practice Address - Street 1:648 BURBANK CIR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1863
Practice Address - Country:US
Practice Address - Phone:770-826-4981
Practice Address - Fax:678-820-2021
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist