Healthcare Provider Details

I. General information

NPI: 1386400562
Provider Name (Legal Business Name): SANDY VUONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 RIVERWOOD PKWY SE
ATLANTA GA
30339-6401
US

IV. Provider business mailing address

2841 AMALFI WAY
LAWRENCEVILLE GA
30044-7807
US

V. Phone/Fax

Practice location:
  • Phone: 219-235-9557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH029574
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: