Provider Demographics
NPI:1215655741
Name:YORK, MICHAEL NOLAND (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NOLAND
Last Name:YORK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 DUFF RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-4718
Mailing Address - Country:US
Mailing Address - Phone:813-735-4391
Mailing Address - Fax:
Practice Address - Street 1:6767 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-6226
Practice Address - Country:US
Practice Address - Phone:863-859-5838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist