MEDICARE: HIEN THI VO PHARM. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH031454	GA

General Provider Information

NPI Number	:	1063058832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIEN THI VO PHARM. D.

Provider Business Mailing Address
First Line	:	54 PROVIDENCE OAK CT
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-5067
Country	:	US
Telephone Number	:	404-324-7483
Fax Number	:

Provider Business Practice Location Address
First Line	:	2675 N DECATUR RD STE 101
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6130
Country	:	US
Telephone Number	:	404-299-5411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	08/19/2020

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