MEDICARE: SIRENA JIA WEI HU PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH030752	GA

General Provider Information

NPI Number	:	1285239574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRENA JIA WEI HU PHARM D

Provider Business Mailing Address
First Line	:	5095 PEACHTREE PKWY
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30092-2524
Country	:	US
Telephone Number	:	770-209-9299
Fax Number	:	770-209-9470

Provider Business Practice Location Address
First Line	:	5095 PEACHTREE PKWY
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30092-2524
Country	:	US
Telephone Number	:	770-209-9299
Fax Number	:	770-209-9470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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