Provider Demographics
NPI:1306350087
Name:THARAKAN, SHIRIN P (PHARM D)
Entity type:Individual
Prefix:
First Name:SHIRIN
Middle Name:P
Last Name:THARAKAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 DICKINSON ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-5027
Mailing Address - Country:US
Mailing Address - Phone:803-318-2640
Mailing Address - Fax:
Practice Address - Street 1:5255 ELVIS PRESLEY BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-8233
Practice Address - Country:US
Practice Address - Phone:901-346-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN41350OtherTENNESSEE BOARD OF PHARMACY