Kennon Latrell Tyre in Blackshear - Pharmacist
Kennon Latrell Tyre - NPI 1629068895
Kennon Latrell Tyre is a Pharmacist in Blackshear, Georgia. Kennon Latrell Tyre practices all healthcare services and medical treatments related to Pharmacist. The NPI Number for Kennon Latrell Tyre is 1629068895. The last update date is 2007-07-08.
Kennon Latrell Tyre's current location address is 937 Dogwood Dr, Blackshear, Georgia. You can contact this provider via phone number 9124498634. The mailing address for Kennon Latrell Tyre is 937 Dogwood Dr, Blackshear, Georgia. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kennon Latrell Tyre |
|---|---|
| Address | 937 Dogwood Dr, Blackshear, Georgia |
| Phone Number | 9124498634 |
| Fax Number | |
| Sole Proprietor | X |
| Credentials | PHARM.D. |
NPI Number Detail
| NPI Number | 1629068895 |
|---|---|
| Provider Enumeration Date | 2005-10-27 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 937 Dogwood Dr |
|---|---|
| City | Blackshear |
| State | Georgia (GA) |
| Post Code | 315162302 |
| Phone Number | 9124498634 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Pharmacist |
|---|---|
| Taxonomy | 183500000X |
| Licence No | 18517 |
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Definition: An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or m |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 18517 | GA | GA LICENSE |
Post Comment/ Review Below
What is the unique identifier code issued to Kennon Latrell Tyre by the Centers for Medicare & Medicaid Services?
The Kennon Latrell Tyre has been assigned the NPI (National Provider Identifier) 1629068895. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete address where Kennon Latrell Tyre is physically located?
The Kennon Latrell Tyre is situated at the following address: 937 Dogwood Dr, Blackshear, GA 315162302.
What is Kennon Latrell Tyre's specialized field of practice, and what is the corresponding taxonomy classification code?
The Kennon Latrell Tyre's area of specialization is Pharmacist, and the corresponding taxonomy code that categorizes this field of practice is 183500000X.
On what date did the Centers for Medicare & Medicaid Services assign the 1629068895 to Kennon Latrell Tyre?
The Centers for Medicare & Medicaid Services assigned the 1629068895 to Kennon Latrell Tyre on 2005-10-27.
As of what date were the details pertaining to Kennon Latrell Tyre last refreshed?
The information related to the Kennon Latrell Tyre, including its address, specialty, and other relevant details, was last updated on 2007-07-08.