Provider Demographics
NPI:1063111417
Name:LAD, ISHANI RAJESHKUMAR (PHARMD)
Entity type:Individual
Prefix:
First Name:ISHANI
Middle Name:RAJESHKUMAR
Last Name:LAD
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 1:408 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1127
Mailing Address - Country:US
Mailing Address - Phone:615-563-2332
Mailing Address - Fax:
Practice Address - Street 1:408 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1127
Practice Address - Country:US
Practice Address - Phone:615-563-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000045300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist