Provider Demographics
NPI:1215204599
Name:STONE, GEORGE ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ROBERT
Last Name:STONE
Suffix:
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 1:10411 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1571
Mailing Address - Country:US
Mailing Address - Phone:210-979-6575
Mailing Address - Fax:210-979-6612
Practice Address - Street 1:10411 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1571
Practice Address - Country:US
Practice Address - Phone:210-979-6575
Practice Address - Fax:210-979-6612
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist