Provider Demographics
NPI:1104219658
Name:STREIN, GEORGE WILLIAM JR (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:STREIN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5211
Mailing Address - Country:US
Mailing Address - Phone:914-388-3490
Mailing Address - Fax:559-751-6115
Practice Address - Street 1:35 JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5211
Practice Address - Country:US
Practice Address - Phone:914-388-3490
Practice Address - Fax:559-751-6115
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.027648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist