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General NPI Number Information
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NPI Number | 1821442153
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Entity Type | Organization
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Legal Business Name | LYHKA5 LLC
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 4470 SATELLITE BLVD STE 108
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City | DULUTH
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State | GA
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Zip | 30096-8852
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Country | US
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Telephone | 470-268-8922
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Fax |
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Provider Business Mailing Address
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Address Line | 4470 SATELLITE BLVD STE 108
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City | DULUTH
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State | GA
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Zip | 30096-8852
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Country | US
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Telephone | 470-268-8922
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Fax | 470-268-8927
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANNA N TRAN
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Credential | PHARM D.
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Telephone | 678-622-9234
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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 | PHRE010287
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE010287
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License Number State | GA
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