Healthcare Provider Details

I. General information

NPI: 1336265396
Provider Name (Legal Business Name): ST GEORGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 STUYVESANT PL
STATEN ISLAND NY
10301-1917
US

IV. Provider business mailing address

99 STUYVESANT PL
STATEN ISLAND NY
10301-1917
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0333
  • Fax:
Mailing address:
  • Phone: 718-447-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number034093
License Number StateNY

VIII. Authorized Official

Name: DR. OMAR S. MOHAMED
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 718-447-0333