Provider Demographics
NPI:1285308189
Name:NNANNA, GEORGINA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GEORGINA
Middle Name:
Last Name:NNANNA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W LOOP 250 N STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3166
Mailing Address - Country:US
Mailing Address - Phone:219-381-5178
Mailing Address - Fax:
Practice Address - Street 1:4400 W LOOP 250 N STE 102
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3166
Practice Address - Country:US
Practice Address - Phone:219-381-5178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist