Provider Demographics
NPI:1568074003
Name:NGUYEN, THU THAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:THU THAO
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:THAO
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2675 N DECATUR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6130
Mailing Address - Country:US
Mailing Address - Phone:404-299-5411
Mailing Address - Fax:404-299-8370
Practice Address - Street 1:2675 N DECATUR RD STE 101
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6130
Practice Address - Country:US
Practice Address - Phone:404-299-5411
Practice Address - Fax:404-299-8370
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist