Provider Demographics
NPI:1124339965
Name:NORMAN, NATHANIEL GRAHAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:GRAHAM
Last Name:NORMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5478 HIGHWAY 153
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3782
Mailing Address - Country:US
Mailing Address - Phone:423-875-0855
Mailing Address - Fax:423-875-3164
Practice Address - Street 1:3508 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-1208
Practice Address - Country:US
Practice Address - Phone:423-624-6584
Practice Address - Fax:423-624-1981
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000029429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist