Healthcare Provider Details

I. General information

NPI: 1023142304
Provider Name (Legal Business Name): NOMORA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 WILLINGHAM AVENUE
BALDWIN GA
30511
US

IV. Provider business mailing address

P.O. BOX 910
BALDWIN GA
30511
US

V. Phone/Fax

Practice location:
  • Phone: 706-778-7174
  • Fax: 706-778-3405
Mailing address:
  • Phone: 706-778-7174
  • Fax: 706-778-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRE008121
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE008121
License Number StateGA

VIII. Authorized Official

Name: MR. GEORGE ELROD
Title or Position: OWNER/PHARMACIST
Credential: R.PH.
Phone: 706-338-9416