Provider Demographics
NPI:1760931919
Name:TORNABENE, WILLA XU QIANG (PHARM D)
Entity Type:Individual
Prefix:
First Name:WILLA
Middle Name:XU QIANG
Last Name:TORNABENE
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 1:200 TECHNOLOGY CT SE STE B
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5201
Mailing Address - Country:US
Mailing Address - Phone:770-437-8040
Mailing Address - Fax:770-437-8411
Practice Address - Street 1:200 TECHNOLOGY CT SE STE B
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5201
Practice Address - Country:US
Practice Address - Phone:770-437-8040
Practice Address - Fax:770-437-8411
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist