Healthcare Provider Details

I. General information

NPI: 1407763550
Provider Name (Legal Business Name): GAU SOUA ANGELIA YANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2463 HAMILTON MILL PKWY
DACULA GA
30019-4648
US

IV. Provider business mailing address

2463 HAMILTON MILL PKWY
DACULA GA
30019-4648
US

V. Phone/Fax

Practice location:
  • Phone: 770-614-1076
  • Fax:
Mailing address:
  • Phone: 770-614-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036451
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: