Mohemmed Yusuf Gangat
Individual provider Active NPI Pharmacist · Jonesborough, TN
NPI 1487945820 · NPPES record last updated Apr 19, 2011
Key facts
- NPI
- 1487945820
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0000012396 (TN)
- Practice address
- 417 Boones Creek Rd
Jonesborough, TN 37659-5165 - Phone
- (423) 753-9701
- NPI assigned
- Apr 19, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000012396 | TN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0000012396 | TN | Yes |
Addresses
Primary practice location
417 Boones Creek Rd
Jonesborough, TN 37659-5165
Mailing address
15 Larchmont LN
Johnson City, TN 37604-6384
Phone (423) 926-4436
Other providers in Jonesborough, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.