Provider Demographics
NPI:1215549035
Name:TAWASHA, NICHOLAS NADER (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:NADER
Last Name:TAWASHA
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 1:4310 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3853
Mailing Address - Country:US
Mailing Address - Phone:502-962-2876
Mailing Address - Fax:502-966-5674
Practice Address - Street 1:4310 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3853
Practice Address - Country:US
Practice Address - Phone:502-962-2876
Practice Address - Fax:502-966-5674
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY020027OtherKENTUCKY BOARD OF PHARMACY