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General NPI Number Information
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NPI Number | 1023618469
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Entity Type | Individual
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Provider Name | MAI THANH T HA
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 8424 MALL PKWY
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City | LITHONIA
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State | GA
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Zip | 30038-2979
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Country | US
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Telephone | 770-225-0394
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Fax |
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Provider Business Mailing Address
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Address Line | 5525 WINSTON CT
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City | CUMMING
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State | GA
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Zip | 30040-9299
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Country | US
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Telephone | 404-545-3776
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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 | RPH029902
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License Number State | GA
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