Healthcare Provider Details

I. General information

NPI: 1457952376
Provider Name (Legal Business Name): NGOCTRAM NGUYEN VU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 SARDIS CHURCH RD
BUFORD GA
30519-6019
US

IV. Provider business mailing address

3250 SARDIS CHURCH RD
BUFORD GA
30519-6019
US

V. Phone/Fax

Practice location:
  • Phone: 678-546-6406
  • Fax: 678-546-6454
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH024562
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: