Provider Demographics
NPI:1518558717
Name:DENNIS, NINA UZOAMAKA CHUKWURA (PHARMD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:UZOAMAKA CHUKWURA
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:UZOAMAKA
Other - Last Name:CHUKWURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:125 PAVILION PKWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 PAVILION PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4098
Practice Address - Country:US
Practice Address - Phone:770-460-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist