Provider Demographics
NPI:1124398540
Name:GEORGE, KEVIN WAYNE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WAYNE
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 S STATE HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-2519
Mailing Address - Country:US
Mailing Address - Phone:254-865-2417
Mailing Address - Fax:254-865-4024
Practice Address - Street 1:2513 S STATE HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-2519
Practice Address - Country:US
Practice Address - Phone:254-865-2417
Practice Address - Fax:254-865-4024
Is Sole Proprietor?:No
Enumeration Date:2012-01-02
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist