Provider Demographics
NPI:1831744242
Name:AHN, SEOK HWAN
Entity type:Individual
Prefix:
First Name:SEOK HWAN
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 LYNNRAY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4453
Mailing Address - Country:US
Mailing Address - Phone:954-815-2032
Mailing Address - Fax:
Practice Address - Street 1:375 ROCKBRIDGE RD NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8225
Practice Address - Country:US
Practice Address - Phone:770-806-4045
Practice Address - Fax:770-806-4050
Is Sole Proprietor?:No
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist