Provider Demographics
NPI:1588947253
Name:NUNNALLY, OLIVIA GRACE (PHARMD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GRACE
Last Name:NUNNALLY
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 1:100 FIELDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2773
Mailing Address - Country:US
Mailing Address - Phone:205-631-1373
Mailing Address - Fax:
Practice Address - Street 1:100 FIELDSTOWN RD
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2773
Practice Address - Country:US
Practice Address - Phone:205-631-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist