Provider Demographics
NPI:1710254628
Name:COLE, TAMISHA
Entity Type:Individual
Prefix:
First Name:TAMISHA
Middle Name:
Last Name:COLE
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 1:5333 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4566
Mailing Address - Country:US
Mailing Address - Phone:901-368-6921
Mailing Address - Fax:
Practice Address - Street 1:5333 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4566
Practice Address - Country:US
Practice Address - Phone:901-368-6921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35578183500000X
MSE-010836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist