Provider Demographics
NPI:1841585320
Name:CHRISTIAN, KISHA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KISHA
Middle Name:MARIE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KISHA
Other - Middle Name:MARIE
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2195 HIGHWAY 20 SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2028
Mailing Address - Country:US
Mailing Address - Phone:404-317-7350
Mailing Address - Fax:
Practice Address - Street 1:2195 HIGHWAY 20 SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2028
Practice Address - Country:US
Practice Address - Phone:404-317-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist