Provider Demographics
NPI:1366721359
Name:NOLAN, TODD D (RPH)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:D
Last Name:NOLAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531A HIGHWAY 20 SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2879
Mailing Address - Country:US
Mailing Address - Phone:770-922-2467
Mailing Address - Fax:
Practice Address - Street 1:3531A HIGHWAY 20 SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2879
Practice Address - Country:US
Practice Address - Phone:770-922-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist