Provider Demographics
NPI:1578737953
Name:LANHAM, KYSHA LAURELLE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KYSHA
Middle Name:LAURELLE
Last Name:LANHAM
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 1:129 GILL ST
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701
Mailing Address - Country:US
Mailing Address - Phone:865-984-7704
Mailing Address - Fax:865-984-6220
Practice Address - Street 1:129 GILL ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2656
Practice Address - Country:US
Practice Address - Phone:865-984-7704
Practice Address - Fax:865-984-6220
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC9910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist