Mandy Dishner, PHARM.D.
Individual provider Active NPI Pharmacist · Gray, TN
NPI 1497066609 · NPPES record last updated Jun 23, 2010
Key facts
- NPI
- 1497066609
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH022593 (GA)
- Practice address
- 5104 Bobby Hicks Hwy
Gray, TN 37615-6217 - Phone
- (423) 477-3372
- Fax
- (423) 477-8533
- NPI assigned
- Jun 23, 2010
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH022593 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 30853 | TN | |
| Pharmacist | 183500000X | RPH022593 | GA | Yes |
Addresses
Primary practice location
5104 Bobby Hicks Hwy
Gray, TN 37615-6217
Mailing address
5104 Bobby Hicks Hwy
Gray, TN 37615-6217
Phone (423) 477-3372
Other providers in Gray, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.