Provider Demographics
NPI:1023142304
Name:NOMORA CORP
Entity type:Organization
Organization Name:NOMORA CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/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:706-338-9416
Mailing Address - Street 1:P.O. BOX 910
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:GA
Mailing Address - Zip Code:30511
Mailing Address - Country:US
Mailing Address - Phone:706-778-7174
Mailing Address - Fax:706-778-3405
Practice Address - Street 1:1667 WILLINGHAM AVENUE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:GA
Practice Address - Zip Code:30511
Practice Address - Country:US
Practice Address - Phone:706-778-7174
Practice Address - Fax:706-778-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0081213336C0003X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1117159OtherNCPDP
GA1117159OtherNCPDP
GA00769161AMedicaid