Individual
ALEXANDRE IVANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2512 YOUNG AMERICA DR, LAWRENCEVILLE, GA 30043-8002
(909) 224-4220
Mailing address
2512 YOUNG AMERICA DR, LAWRENCEVILLE, GA 30043-8002
Taxonomy
Speciality
Code
Description
License number
State
1835N1003X
Nutrition Support Pharmacist
Primary
RPH029265
GA
Other
Enumeration date
10/29/2025
Last updated
10/29/2025
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