1689957185 NPI number — NORA OLIVIA NANTEZA-MUKASA BS PHARM, PHARMD

Table of content: SHELBY EDINGTON PT, DPT (NPI 1215756929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689957185 NPI number — NORA OLIVIA NANTEZA-MUKASA BS PHARM, PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NANTEZA-MUKASA
Provider First Name:
NORA
Provider Middle Name:
OLIVIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS PHARM, PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689957185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3399 LAKE MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFORD
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30519-5348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-482-4756
Provider Business Mailing Address Fax Number:
678-482-4756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2630 BRASELTON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFORD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30519-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-546-7328
Provider Business Practice Location Address Fax Number:
678-546-8013
Provider Enumeration Date:
09/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH022830 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: PH25280 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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