Provider Demographics
NPI:1144529355
Name:RISH, TINA A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:A
Last Name:RISH
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 1:300 KNOX ABBOTT DR
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-4395
Mailing Address - Country:US
Mailing Address - Phone:803-926-4974
Mailing Address - Fax:803-926-8754
Practice Address - Street 1:300 KNOX ABBOTT DR
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-4395
Practice Address - Country:US
Practice Address - Phone:803-926-4974
Practice Address - Fax:803-926-8754
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12335OtherSTATE LICENSE NUMBER