Provider Demographics
NPI:1558412098
Name:MAURER, GEORGE FREDERICK (RPH,CCN,NDM)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:FREDERICK
Last Name:MAURER
Suffix:
Gender:M
Credentials:RPH,CCN,NDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-7729
Mailing Address - Country:US
Mailing Address - Phone:812-448-1881
Mailing Address - Fax:812-448-2190
Practice Address - Street 1:555 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-7729
Practice Address - Country:US
Practice Address - Phone:812-448-1881
Practice Address - Fax:812-448-2190
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012942A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0456470001Medicare ID - Type Unspecified