Provider Demographics
NPI:1245356252
Name:ELAM, NANCY (RPH)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ELAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4256 WHISPERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4951
Mailing Address - Country:US
Mailing Address - Phone:229-247-4409
Mailing Address - Fax:
Practice Address - Street 1:3200 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1745
Practice Address - Country:US
Practice Address - Phone:229-242-3007
Practice Address - Fax:229-242-5831
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH021023OtherPHARMACIST LICENSE NUMBER