Provider Demographics
NPI:1710276886
Name:MAI, NATALIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:MAI
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 1:3545 HICKORY BRANCH TRL
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7041
Mailing Address - Country:US
Mailing Address - Phone:770-932-8234
Mailing Address - Fax:
Practice Address - Street 1:3545 HICKORY BRANCH TRL
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:770-932-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202-012854183500000X
NV14073183500000X
GA020191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist