Provider Demographics
NPI:1023801388
Name:YARBROUGH, NICHOLAS BRAEDEN (PHARMD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BRAEDEN
Last Name:YARBROUGH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-3815
Mailing Address - Country:US
Mailing Address - Phone:601-479-1013
Mailing Address - Fax:
Practice Address - Street 1:219 N WOODLAND DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-3307
Practice Address - Country:US
Practice Address - Phone:601-469-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-101954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist