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General NPI Number Information
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NPI Number | 1902404643
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Entity Type | Individual
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Provider Name | BRIAN GEORGE
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Gender | Male
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 335 GLESSNER AVE
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City | MANSFIELD
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State | OH
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Zip | 44903-2269
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Country | US
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Telephone | 419-526-8843
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Fax |
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Provider Business Mailing Address
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Address Line | 4363 ALGIRE RD
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City | LEXINGTON
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State | OH
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Zip | 44904-9576
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 03321735
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License Number State | OH
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