Provider Demographics
NPI:1417295098
Name:CHHANG, VANNY STEPHANIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:VANNY
Middle Name:STEPHANIE
Last Name:CHHANG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 FIVE FORKS TRICKUM RD SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2351
Mailing Address - Country:US
Mailing Address - Phone:770-381-4176
Mailing Address - Fax:770-381-7559
Practice Address - Street 1:4045 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2351
Practice Address - Country:US
Practice Address - Phone:770-381-4176
Practice Address - Fax:770-381-7559
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist