Provider Demographics
NPI:1487999363
Name:CARRILLO, NANCY WILLIAMS (RPH)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:WILLIAMS
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3446 WINDER HWY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3007
Mailing Address - Country:US
Mailing Address - Phone:770-538-4276
Mailing Address - Fax:770-503-9677
Practice Address - Street 1:3446 WINDER HWY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3007
Practice Address - Country:US
Practice Address - Phone:770-538-4276
Practice Address - Fax:770-503-9677
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13259183500000X
GARPH013939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist