Provider Demographics
NPI:1033491865
Name:HANDFORD-TUTT, QWANYU
Entity Type:Individual
Prefix:
First Name:QWANYU
Middle Name:
Last Name:HANDFORD-TUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 OLD NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2100
Mailing Address - Country:US
Mailing Address - Phone:678-407-9136
Mailing Address - Fax:678-407-9268
Practice Address - Street 1:2500 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2100
Practice Address - Country:US
Practice Address - Phone:678-407-9136
Practice Address - Fax:678-407-9268
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist