Provider Demographics
NPI:1053606673
Name:NELSON, JACINTA CHANTE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JACINTA
Middle Name:CHANTE
Last Name:NELSON
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 1:8109 MALL PKWY
Mailing Address - Street 2:T-1909
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2546
Mailing Address - Country:US
Mailing Address - Phone:678-259-0047
Mailing Address - Fax:678-259-0047
Practice Address - Street 1:8109 MALL PKWY
Practice Address - Street 2:T-1909
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2546
Practice Address - Country:US
Practice Address - Phone:678-259-0047
Practice Address - Fax:678-259-0047
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist