Provider Demographics
NPI:1861526501
Name:NOMORA CORPORATION
Entity type:Organization
Organization Name:NOMORA CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELROD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-795-0920
Mailing Address - Street 1:7 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:DANIELSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30633-7051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:DANIELSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30633-7051
Practice Address - Country:US
Practice Address - Phone:706-795-0920
Practice Address - Fax:706-795-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0082313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00785353AMedicaid
GA1144877OtherNCPDP
GABN5776438OtherDEA
GA00785353AMedicaid