Provider Demographics
NPI:1356078026
Name:KAPAN, SHIYAR (RPH)
Entity type:Individual
Prefix:
First Name:SHIYAR
Middle Name:
Last Name:KAPAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HARVEST CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-4827
Mailing Address - Country:US
Mailing Address - Phone:615-397-5653
Mailing Address - Fax:
Practice Address - Street 1:203 HARVEST CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-4827
Practice Address - Country:US
Practice Address - Phone:615-397-5653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP10177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP10177OtherIDAHO STATE BOARD OF PHARMACY LICENSING #