Provider Demographics
NPI:1881209146
Name:DITAH, FELICIA TAWAH CHE
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:TAWAH CHE
Last Name:DITAH
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 1:384 OIL WELL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7929
Mailing Address - Country:US
Mailing Address - Phone:731-664-8892
Mailing Address - Fax:731-661-9195
Practice Address - Street 1:384 OIL WELL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7929
Practice Address - Country:US
Practice Address - Phone:731-664-8892
Practice Address - Fax:731-661-9195
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist