Provider Demographics
NPI:1548556996
Name:CAI, QUYEN (PHARMD)
Entity type:Individual
Prefix:
First Name:QUYEN
Middle Name:
Last Name:CAI
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 1:5220 JIMMY LEE SMITH PKWY
Mailing Address - Street 2:T-1400
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2739
Mailing Address - Country:US
Mailing Address - Phone:770-222-1421
Mailing Address - Fax:770-222-1421
Practice Address - Street 1:5220 JIMMY LEE SMITH PKWY
Practice Address - Street 2:T-1400
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2739
Practice Address - Country:US
Practice Address - Phone:770-222-1421
Practice Address - Fax:770-222-1421
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025340183500000X
FLPS42431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist