Provider Demographics
NPI:1154761302
Name:PACHAN, TRISTA LEIGH (PHARMD)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:LEIGH
Last Name:PACHAN
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 1:1700 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7905
Mailing Address - Country:US
Mailing Address - Phone:336-574-1599
Mailing Address - Fax:336-272-7236
Practice Address - Street 1:1700 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7905
Practice Address - Country:US
Practice Address - Phone:336-574-1599
Practice Address - Fax:336-272-7236
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist