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Organization
GIOVANNI NIRMALA
Active
Organization
GIOVANNI NIRMALA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIKKI BROADNEAUX PHARMD (CHIEF EXECUTIVE OFFICER)
(414) 418-0530
Entity
Organization
Contact information
Practice address
477 TALLWOOD DR, STONE MOUNTAIN, GA 30083-4461
(414) 418-0530
Mailing address
477 TALLWOOD DR, STONE MOUNTAIN, GA 30083-4461
(414) 418-0530
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Enumeration date
05/25/2011
Last updated
05/25/2011
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