Provider Demographics
NPI:1336219302
Name:YARWORTH, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:YARWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRACY CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37387-4020
Mailing Address - Country:US
Mailing Address - Phone:931-592-9190
Mailing Address - Fax:931-592-9203
Practice Address - Street 1:740 MAIN ST
Practice Address - Street 2:
Practice Address - City:TRACY CITY
Practice Address - State:TN
Practice Address - Zip Code:37387-4020
Practice Address - Country:US
Practice Address - Phone:931-592-9190
Practice Address - Fax:931-592-9203
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43341835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0325290001Medicare NSC