Provider Demographics
NPI:1194361246
Name:ABOU-RJAILY, GEORGE AMIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:AMIN
Last Name:ABOU-RJAILY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17447 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-9542
Mailing Address - Country:US
Mailing Address - Phone:419-283-2142
Mailing Address - Fax:
Practice Address - Street 1:17447 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-9542
Practice Address - Country:US
Practice Address - Phone:419-283-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist