Provider Demographics
NPI:1033702766
Name:TIRAO, NICOLE ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:TIRAO
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 1:1955 E MONTGOMERY XRD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5036
Mailing Address - Country:US
Mailing Address - Phone:912-351-0743
Mailing Address - Fax:912-351-0691
Practice Address - Street 1:1955 E MONTGOMERY XRD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5036
Practice Address - Country:US
Practice Address - Phone:912-351-0743
Practice Address - Fax:912-351-0691
Is Sole Proprietor?:No
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist