Healthcare Provider Details

I. General information

NPI: 1699300970
Provider Name (Legal Business Name): PHUONG VU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2020
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4357 LAWRENCEVILLE HWY
TUCKER GA
30084-3773
US

IV. Provider business mailing address

1250 WATER SHINE WAY
SNELLVILLE GA
30078-7744
US

V. Phone/Fax

Practice location:
  • Phone: 770-934-8322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH031710
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: