Provider Demographics
NPI:1043823677
Name:GEORGE, MINU (PHARMD)
Entity Type:Individual
Prefix:
First Name:MINU
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MINU
Other - Middle Name:KOTHETH
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1600 N NOVA RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-2405
Mailing Address - Country:US
Mailing Address - Phone:386-255-0485
Mailing Address - Fax:386-257-4052
Practice Address - Street 1:1600 N NOVA RD
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-2405
Practice Address - Country:US
Practice Address - Phone:386-255-0485
Practice Address - Fax:386-257-4052
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist