MEDICARE: MRS. AQUILINA 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	PS 30705	FL

General Provider Information

NPI Number	:	1730475567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AQUILINA GEORGE

Provider Business Mailing Address
First Line	:	4450 PARK ST N
Second Line	:	T-1023
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-4020
Country	:	US
Telephone Number	:	727-541-3930
Fax Number	:	727-541-3930

Provider Business Practice Location Address
First Line	:	4450 PARK ST N
Second Line	:	T-1023
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-4020
Country	:	US
Telephone Number	:	727-541-3930
Fax Number	:	727-541-3930

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

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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