Provider Demographics
NPI:1518506237
Name:GEORGION, CARRIE NICOLE (PHARM D, BSPS, BS, B)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:NICOLE
Last Name:GEORGION
Suffix:
Gender:F
Credentials:PHARM D, BSPS, BS, B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 GARNET DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-5300
Mailing Address - Country:US
Mailing Address - Phone:219-406-6824
Mailing Address - Fax:
Practice Address - Street 1:55 PINE LAKE AVE
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3027
Practice Address - Country:US
Practice Address - Phone:219-325-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022936A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist