Healthcare Provider Details

I. General information

NPI: 1134329154
Provider Name (Legal Business Name): VIVIAN MEIHUAN ZHAO PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1431 DRUID VALLEY DR NE APT D
ATLANTA GA
30329-2938
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-7794
  • Fax:
Mailing address:
  • Phone: 404-712-7794
  • Fax: 404-712-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberRPH023313
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: