Provider Demographics
NPI:1598065286
Name:GEORGE, PHUONG (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PHUONG
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14444 124TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4801
Mailing Address - Country:US
Mailing Address - Phone:425-821-7455
Mailing Address - Fax:425-820-6384
Practice Address - Street 1:14444 124TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4801
Practice Address - Country:US
Practice Address - Phone:425-821-7455
Practice Address - Fax:425-820-6384
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist