Provider Demographics
NPI:1568789923
Name:MANSOOR, GEORGE NAZAR
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:NAZAR
Last Name:MANSOOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 WING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-2960
Mailing Address - Country:US
Mailing Address - Phone:248-626-1155
Mailing Address - Fax:
Practice Address - Street 1:6914 WING LAKE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-2960
Practice Address - Country:US
Practice Address - Phone:248-626-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist