Provider Demographics
NPI:1598159493
Name:SAINT GEORGE & SAINT MOSES LLC
Entity Type:Organization
Organization Name:SAINT GEORGE & SAINT MOSES LLC
Other - Org Name:THE DRUGSTORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALFONSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GHALI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-708-7500
Mailing Address - Street 1:19 CR 4114 SUITE 1
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686
Mailing Address - Country:US
Mailing Address - Phone:903-708-7500
Mailing Address - Fax:903-708-7508
Practice Address - Street 1:19 COUNTY ROAD 4114
Practice Address - Street 2:SUITE 1
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686
Practice Address - Country:US
Practice Address - Phone:903-708-7500
Practice Address - Fax:903-708-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29889OtherTSBP
TX29889OtherTSBP