Provider Demographics
NPI:1003464538
Name:HASAN, NICHOLE ABERNATHY (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ABERNATHY
Last Name:HASAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 TAMERTON TRCE
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4249
Mailing Address - Country:US
Mailing Address - Phone:404-210-6326
Mailing Address - Fax:
Practice Address - Street 1:WALMART PHARMACY
Practice Address - Street 2:3827 MUNDY MILL RD
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566
Practice Address - Country:US
Practice Address - Phone:770-535-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist