Provider Demographics
NPI:1720387129
Name:GEETHA, NISHI (RPH)
Entity Type:Individual
Prefix:
First Name:NISHI
Middle Name:
Last Name:GEETHA
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 1:1489 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3875
Mailing Address - Country:US
Mailing Address - Phone:931-553-0254
Mailing Address - Fax:931-553-4137
Practice Address - Street 1:1489 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3875
Practice Address - Country:US
Practice Address - Phone:931-553-0254
Practice Address - Fax:931-553-4137
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist