Healthcare Provider Details

I. General information

NPI: 1700874070
Provider Name (Legal Business Name): GEORGE HALL MCCOLSKEY PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S MARION AVE
LAKE CITY FL
32025-5808
US

IV. Provider business mailing address

224 SE PINE DR
LAKE CITY FL
32025-6887
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-3016
  • Fax: 386-754-6306
Mailing address:
  • Phone: 386-752-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: