Provider Demographics
NPI:1134830565
Name:ELSHAZLY, NORA
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:ELSHAZLY
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 1:98 BUFORD DAM RD APT 3205
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-3274
Mailing Address - Country:US
Mailing Address - Phone:850-252-3499
Mailing Address - Fax:
Practice Address - Street 1:5475 BETHELVIEW RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9731
Practice Address - Country:US
Practice Address - Phone:678-455-1238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist