Healthcare Provider Details

I. General information

NPI: 1447111265
Provider Name (Legal Business Name): DULUTH MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 PLEASANT HILL RD STE 101B
DULUTH GA
30096-4807
US

IV. Provider business mailing address

6455 JONES CREEK CT
SUWANEE GA
30024-3479
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-2820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: QUYNH DAO
Title or Position: OWNER
Credential:
Phone: 770-330-8969