Provider Demographics
NPI:1508485061
Name:NASRALLA, MARTINA KARAM AIAD (RPH)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:KARAM AIAD
Last Name:NASRALLA
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 1:6849 HICKORY RIM CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5690
Mailing Address - Country:US
Mailing Address - Phone:615-608-8986
Mailing Address - Fax:
Practice Address - Street 1:312 E GAINES ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3532
Practice Address - Country:US
Practice Address - Phone:931-762-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN43714OtherTENNESSEE BOARD OF PHARMACY