Provider Demographics
NPI:1326444720
Name:VANDSE, NISHI
Entity Type:Individual
Prefix:MRS
First Name:NISHI
Middle Name:
Last Name:VANDSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2996
Mailing Address - Country:US
Mailing Address - Phone:732-476-4186
Mailing Address - Fax:
Practice Address - Street 1:83 DORCHESTER DR
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2996
Practice Address - Country:US
Practice Address - Phone:732-476-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03326500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist