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
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.