Provider Demographics
NPI:1689957185
Name:NANTEZA-MUKASA, NORA OLIVIA (BS PHARM, PHARMD)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:OLIVIA
Last Name:NANTEZA-MUKASA
Suffix:
Gender:F
Credentials:BS PHARM, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 LAKE MILL RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-5348
Mailing Address - Country:US
Mailing Address - Phone:678-482-4756
Mailing Address - Fax:678-482-4756
Practice Address - Street 1:2630 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-5215
Practice Address - Country:US
Practice Address - Phone:678-546-7328
Practice Address - Fax:678-546-8013
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022830183500000X
MAPH25280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist