MEDICARE: FATEN&GEORGE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1093543357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FATEN&GEORGE, LLC

Provider Business Mailing Address
First Line	:	40164 US HIGHWAY 19 N
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-8333
Country	:	US
Telephone Number	:	727-934-4490
Fax Number	:	727-934-4730

Provider Business Practice Location Address
First Line	:	40164 US HIGHWAY 19 N
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-8333
Country	:	US
Telephone Number	:	727-934-4490
Fax Number	:	727-934-4730

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	SAMEH FARAGALLAH
Credential	:	RPH
Telephone Number	:	727-934-4490

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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Directions to “FATEN&GEORGE, LLC ” Practice Location

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