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General NPI Number Information
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NPI Number | 1487945820
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Entity Type | Individual
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Provider Name | MR. MOHEMMED YUSUF GANGAT
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Gender | Male
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 417 BOONES CREEK RD
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City | JONESBOROUGH
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State | TN
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Zip | 37659-5165
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Country | US
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Telephone | 423-753-9701
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Fax |
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Provider Business Mailing Address
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Address Line | 15 LARCHMONT LN
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City | JOHNSON CITY
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State | TN
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Zip | 37604-6384
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Country | US
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Telephone | 423-926-4436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0000012396
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License Number State | TN
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