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NPI 1851269823

IndividualActive

Alexandre Ivanov

NPI 1851269823 · Nutrition Support Pharmacist · Lawrenceville, GA

Provider details

NPI number: 1851269823
Entity type: Individual
Primary specialty: Nutrition Support PharmacistPharmacy Service Providers
Sex: Male
Sole proprietor: Yes
License: RPH029265 (GA)

Practice location

2512 Young America Dr

Lawrenceville, GA 30043-8002

Phone: (909) 224-4220

More GA providers

Mailing address

2512 Young America Dr

Lawrenceville, GA 30043-8002

Registry dates

Enumerated: 2025-10-29
Last updated: 2025-10-29

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Alexandre Ivanov — NPI 1851269823, Lawrenceville, GA | NPI Central