Provider Demographics
NPI:1003407222
Name:GEORGE, RIJO
Entity Type:Individual
Prefix:
First Name:RIJO
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 N JERUSALEM RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1234
Mailing Address - Country:US
Mailing Address - Phone:516-509-9435
Mailing Address - Fax:
Practice Address - Street 1:1634 N JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:NORTH MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1234
Practice Address - Country:US
Practice Address - Phone:516-509-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1063916-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1063916-01OtherPHARMACIST LICENSE