MEDICARE: MR. GEORGE LIVINGSTON WITT

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	32229	TX

General Provider Information

NPI Number	:	1134424344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE LIVINGSTON WITT

Provider Business Mailing Address
First Line	:	4115 REED RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77051-2711
Country	:	US
Telephone Number	:	713-731-1919
Fax Number	:	713-731-7500

Provider Business Practice Location Address
First Line	:	4115 REED RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77051-2711
Country	:	US
Telephone Number	:	713-731-1919
Fax Number	:	713-731-7500

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

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	01/19/2011

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