Individual
NHO CAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3341 SERENADE CT, ALPHARETTA, GA 30004-4908
(863) 832-9240
Mailing address
3341 SERENADE CT, ALPHARETTA, GA 30004-4908
(863) 832-9240
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PHI-023727
GA
183700000X
Pharmacy Technician
Primary
—
—
Other
Enumeration date
06/13/2022
Last updated
03/13/2026
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