Provider Demographics
NPI:1265433387
Name:NYKAMP MCCORTER, DIANE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:NYKAMP MCCORTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:NYKAMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3001 MERCER UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4115
Mailing Address - Country:US
Mailing Address - Phone:678-547-6219
Mailing Address - Fax:678-547-3384
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 490
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-851-7633
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13548183500000X
FL19512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist