MEDICARE: TRUC PHAM

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	RPH035149	GA

General Provider Information

NPI Number	:	1891522702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUC PHAM

Provider Business Mailing Address
First Line	:	1745 HIGHWAY 138 SE STE A
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-5710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1745 HIGHWAY 138 SE STE A
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-5710
Country	:	US
Telephone Number	:	770-922-0447
Fax Number	:

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2024

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Directions to “ TRUC PHAM ” Practice Location

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