Provider Demographics
NPI:1174123749
Name:NGUYEN, LAUREN LEANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEANNE
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 1:234 HICKORY BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8773
Mailing Address - Country:US
Mailing Address - Phone:678-860-9947
Mailing Address - Fax:
Practice Address - Street 1:3615 CHARLES HARDY PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-9472
Practice Address - Country:US
Practice Address - Phone:770-445-9096
Practice Address - Fax:770-445-7371
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist