Healthcare Provider Details

I. General information

NPI: 1861526501
Provider Name (Legal Business Name): NOMORA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 JOHNSON DR
DANIELSVILLE GA
30633-7051
US

IV. Provider business mailing address

7 JOHNSON DR
DANIELSVILLE GA
30633-7051
US

V. Phone/Fax

Practice location:
  • Phone: 706-795-0920
  • Fax: 706-795-3025
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE008231
License Number StateGA

VIII. Authorized Official

Name: MR. GEORGE ELROD
Title or Position: PHARMACIST
Credential: R.PH.
Phone: 706-795-0920