Provider Demographics
NPI:1518369016
Name:KOSHY, NISHA
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:KOSHY
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 1:2906 HOUSTON HWY
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4681
Mailing Address - Country:US
Mailing Address - Phone:361-576-5458
Mailing Address - Fax:
Practice Address - Street 1:2906 HOUSTON HWY
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4681
Practice Address - Country:US
Practice Address - Phone:361-576-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist