Provider Demographics
NPI:1801552757
Name:NISHAT, RAISA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RAISA
Middle Name:
Last Name:NISHAT
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 1:150 E FAYETTE ST APT 311
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1642
Mailing Address - Country:US
Mailing Address - Phone:347-421-2543
Mailing Address - Fax:
Practice Address - Street 1:5380 W TAFT RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-3766
Practice Address - Country:US
Practice Address - Phone:315-458-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist