Healthcare Provider Details

I. General information

NPI: 1750606935
Provider Name (Legal Business Name): JIMMY GEORGE BS, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

7436 260TH ST
GLEN OAKS NY
11004-1123
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-3885
  • Fax: 718-883-6122
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048429-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: