MEDICARE: MICHAEL YARWORTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336C0003X	Community/Retail Pharmacy	130	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0325290001	OTHER	TN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2088655	OTHER		PK

General Provider Information

NPI Number	:	1730259722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL YARWORTH

Provider Business Mailing Address
First Line	:	PO BOX 669
Second Line	:
City	:	TRACY CITY
State	:	TN
Zip	:	37387-0669
Country	:	US
Telephone Number	:	931-592-9190
Fax Number	:	931-592-9203

Provider Business Practice Location Address
First Line	:	740 MAIN ST
Second Line	:
City	:	TRACY CITY
State	:	TN
Zip	:	37387
Country	:	US
Telephone Number	:	931-592-9190
Fax Number	:	931-592-9203

Authorized Official
Title or Position	:	OWNER AND CHIEF PHARMACIST
Name	:	MICHAEL YARWORTH
Credential	:	DPH
Telephone Number	:	931-592-9190

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	12/01/2021

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Directions to “MICHAEL YARWORTH ” Practice Location

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