Provider Demographics
NPI:1669066890
Name:DAYISI, MARDHIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARDHIA
Middle Name:
Last Name:DAYISI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 VININGS WALK
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4245
Mailing Address - Country:US
Mailing Address - Phone:770-722-4363
Mailing Address - Fax:
Practice Address - Street 1:415 VININGS WALK
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4245
Practice Address - Country:US
Practice Address - Phone:309-240-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029781183500000X
PARP045340L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist