Healthcare Provider Details

I. General information

NPI: 1942805759
Provider Name (Legal Business Name): HOANG MAI THI NGUYEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6716 MOUNT ZION BLVD
MORROW GA
30260
US

IV. Provider business mailing address

6716 MT ZION BLVD
MORROW GA
30260
US

V. Phone/Fax

Practice location:
  • Phone: 770-960-0600
  • Fax: 770-960-4179
Mailing address:
  • Phone: 770-960-0600
  • Fax: 770-960-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH026677
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: