Provider Demographics
NPI:1316231673
Name:KADANTHODE, RUBINA JOHN
Entity Type:Individual
Prefix:MRS
First Name:RUBINA
Middle Name:JOHN
Last Name:KADANTHODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUBINA
Other - Middle Name:
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7000 THRUSH PL
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6250
Mailing Address - Country:US
Mailing Address - Phone:615-838-5104
Mailing Address - Fax:931-560-2144
Practice Address - Street 1:1202 S JAMES CAMPBELL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-388-9004
Practice Address - Fax:931-840-5742
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN282831835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist