Healthcare Provider Details

I. General information

NPI: 1659974574
Provider Name (Legal Business Name): RAISSA LOUMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 LIBERTY PIKE
FRANKLIN TN
37067-5608
US

IV. Provider business mailing address

1154 LIBERTY PIKE
FRANKLIN TN
37067-5608
US

V. Phone/Fax

Practice location:
  • Phone: 615-791-1164
  • Fax:
Mailing address:
  • Phone: 615-791-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34003
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: