Provider Demographics
NPI:1093016719
Name:TISHK, HARRY NATHAN (RPH)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:NATHAN
Last Name:TISHK
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 1:1568 FIELDBROOK ST.
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-610-6410
Mailing Address - Fax:702-914-3655
Practice Address - Street 1:1568 FIELDBROOK ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-6406
Practice Address - Country:US
Practice Address - Phone:702-610-6410
Practice Address - Fax:702-914-3655
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11419183500000X
AZS012370183500000X
KS1-08372183500000X
MO027131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist