Healthcare Provider Details

I. General information

NPI: 1447383864
Provider Name (Legal Business Name): GEORGE MICHAEL ESCOBAR CDOE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7691 POST RD
NORTH KINGSTOWN RI
02852-3220
US

IV. Provider business mailing address

20 CROSSWYNDS DR
SAUNDERSTOWN RI
02874-2407
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-8811
  • Fax:
Mailing address:
  • Phone: 401-295-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2110
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: