Provider Demographics
NPI:1710361886
Name:JARA, NANCY HOLLASH
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:HOLLASH
Last Name:JARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6197 SPALDING DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1802
Mailing Address - Country:US
Mailing Address - Phone:770-843-7722
Mailing Address - Fax:
Practice Address - Street 1:6197 SPALDING DR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1802
Practice Address - Country:US
Practice Address - Phone:770-843-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017488183500000X
FLPS 28018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist