Provider Demographics
NPI:1629676473
Name:GAO, JIN (RPH)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 GRANBURY WAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-2611
Mailing Address - Country:US
Mailing Address - Phone:404-944-0640
Mailing Address - Fax:
Practice Address - Street 1:11877 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4325
Practice Address - Country:US
Practice Address - Phone:770-751-3651
Practice Address - Fax:770-751-3556
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0204391835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist