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NPI Code Detail

MEDICARE: SAUDIA ALLY PHARMD

MEDICARE: SAUDIA ALLY PHARMD
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
1183500000XPharmacistRPH028974GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RPH028974OTHERGAPHARMACIST LICENSE NUMBER

General Provider Information

NPI Number : 1407200579
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAUDIA ALLY PHARMD
Provider Business Mailing Address
First Line : 930 NEW HOPE RD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045-6407
Country : US
Telephone Number : 770-682-2433
Fax Number :
Provider Business Practice Location Address
First Line : 930 NEW HOPE RD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045-6407
Country : US
Telephone Number : 770-682-2433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2016
Last Update Date : 04/14/2016

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Directions to “ SAUDIA ALLY PHARMD” Practice Location

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