MEDICARE: MELVIS ANN GEORGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	42376	SC
2	183500000X	Pharmacist	29132	NC

General Provider Information

NPI Number	:	1053951863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIS ANN GEORGE

Provider Business Mailing Address
First Line	:	1334 CROWN RIDGE DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8306
Country	:	US
Telephone Number	:	803-554-4245
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 DALLAS CHERRYVILLE HWY
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-8714
Country	:	US
Telephone Number	:	704-648-0912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2020
Last Update Date	:	07/02/2022

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Directions to “ MELVIS ANN GEORGE ” Practice Location

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