Healthcare Provider Details

I. General information

NPI: 1477474344
Provider Name (Legal Business Name): MICHAEL GEORGY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 CUNARD CT
BRISTOW VA
20136-1750
US

IV. Provider business mailing address

1500 GALEN ST SE
WASHINGTON DC
20020-4913
US

V. Phone/Fax

Practice location:
  • Phone: 315-243-2334
  • Fax:
Mailing address:
  • Phone: 202-610-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100002715
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: