Provider Demographics
NPI:1407392285
Name:BASHAR-NTIM, NISHAT (RPH)
Entity Type:Individual
Prefix:
First Name:NISHAT
Middle Name:
Last Name:BASHAR-NTIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2057
Mailing Address - Country:US
Mailing Address - Phone:608-251-4454
Mailing Address - Fax:608-251-3853
Practice Address - Street 1:341 STATE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2057
Practice Address - Country:US
Practice Address - Phone:608-251-4454
Practice Address - Fax:608-251-3853
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16109-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5111098OtherNABP
WI1699793380Medicaid
WI1699793380OtherNPI