MEDICARE: THU THAO NGUYEN 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
1	183500000X	Pharmacist	RPH027464	GA

General Provider Information

NPI Number	:	1568074003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THU THAO NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	2675 N DECATUR RD STE 101
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6130
Country	:	US
Telephone Number	:	404-299-5411
Fax Number	:	404-299-8370

Provider Business Practice Location Address
First Line	:	2675 N DECATUR RD STE 101
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6130
Country	:	US
Telephone Number	:	404-299-5411
Fax Number	:	404-299-8370

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

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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