Provider Demographics
NPI:1174860258
Name:COLON, NORA IVELISSE
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:IVELISSE
Last Name:COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SEVEN HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0574
Mailing Address - Country:US
Mailing Address - Phone:770-975-6791
Mailing Address - Fax:770-975-6796
Practice Address - Street 1:80 SEVEN HILLS BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0574
Practice Address - Country:US
Practice Address - Phone:770-975-6791
Practice Address - Fax:770-975-6796
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist