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General NPI Number Information
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NPI Number | 1013620079
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Entity Type | Individual
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Provider Name | JOHN THAI PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 800 GLENWOOD AVE SE
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City | ATLANTA
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State | GA
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Zip | 30316-1814
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Country | US
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Telephone | 470-447-5040
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Fax |
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Provider Business Mailing Address
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Address Line | 6625 DOTTIE MAE CT
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City | MORROW
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State | GA
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Zip | 30260-2740
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Country | US
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Telephone | 678-650-2540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH034006
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License Number State | GA
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