Provider Demographics
NPI:1275771271
Name:GEORGE, JIMMY SAM (REG PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:SAM
Last Name:GEORGE
Suffix:
Gender:M
Credentials:REG PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E VAN FLEET DR
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-3829
Mailing Address - Country:US
Mailing Address - Phone:863-533-6669
Mailing Address - Fax:863-533-1963
Practice Address - Street 1:155 E VAN FLEET DR
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3829
Practice Address - Country:US
Practice Address - Phone:863-533-6669
Practice Address - Fax:863-533-1963
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist