Provider Demographics
NPI:1497066609
Name:DISHNER, MANDY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:DISHNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 BOBBY HICKS HWY
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6217
Mailing Address - Country:US
Mailing Address - Phone:423-477-3372
Mailing Address - Fax:423-477-8533
Practice Address - Street 1:5104 BOBBY HICKS HWY
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-6217
Practice Address - Country:US
Practice Address - Phone:423-477-3372
Practice Address - Fax:423-477-8533
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30853183500000X
GARPH022593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist