Tyle, LLC
Organization Active NPI Community/Retail Pharmacy · MC Rae, GA
NPI 1467889352 · NPPES record last updated Sep 16, 2024
Key facts
- NPI
- 1467889352
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- TYLE, LLC
- Practice address
- 12 S Second Ave
MC Rae, GA 31055-4659 - Phone
- (229) 868-6735
- Fax
- (229) 868-2611
- NPI assigned
- Oct 9, 2013
- Organization subpart
- No
Authorized official
- Name
- Hugh Lowell Yawn Jr., PHARMD
- Title
- Owner/Pic
- Phone
- (229) 318-9991
Practitioners 1
-
Hugh L Yawn Jr., PHARM. D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140603001340 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 9436372869 | Practice locations: MC Rae, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
12 S Second Ave
MC Rae, GA 31055-4659
Mailing address
PO Box 209
MC Rae, GA 31055-0209
Phone (229) 868-6735
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000035395A | Medicaid | GA |
Other names
- Ryals Drug Store
Other providers in MC Rae, GA
- Telfair County Health Department
- Telfair County Schools
- Telfair Family Chiropractic Center
- Johnny A Troup
- Nacondria Makisa Troupe
- Walk the Talk Speech Therapy LLC
- William J Briggs MD PC
- Hugh L Yawn Jr.
All providers in MC Rae, GA · Community/Retail Pharmacy in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.