Provider Demographics
NPI:1588276877
Name:NGUYEN, PHUONG-THAO THUY (PHARMD)
Entity type:Individual
Prefix:
First Name:PHUONG-THAO
Middle Name:THUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 PHARR COURT SOUTH NW APT 714
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2142
Mailing Address - Country:US
Mailing Address - Phone:678-521-2168
Mailing Address - Fax:
Practice Address - Street 1:2900 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-4915
Practice Address - Country:US
Practice Address - Phone:404-848-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist