MEDICARE: MR. GEORGE MICHAEL STAGG PHARMACIST

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	28RI01728000	NJ

General Provider Information

NPI Number	:	1134150535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE MICHAEL STAGG PHARMACIST

Provider Business Mailing Address
First Line	:	94 WESLEY DR
Second Line	:
City	:	WEST MILFORD
State	:	NJ
Zip	:	07480-1630
Country	:	US
Telephone Number	:	973-697-4169
Fax Number	:

Provider Business Practice Location Address
First Line	:	1481 ROUTE 23
Second Line	:	SUITE 3
City	:	BUTLER
State	:	NJ
Zip	:	07405-1645
Country	:	US
Telephone Number	:	973-492-5400
Fax Number	:	973-492-0099

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/18/2010

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