Provider Demographics
NPI:1699045484
Name:GEORGE, JIBIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JIBIN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 FULLE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1312
Mailing Address - Country:US
Mailing Address - Phone:845-596-3385
Mailing Address - Fax:
Practice Address - Street 1:346 FULLE DR
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1312
Practice Address - Country:US
Practice Address - Phone:845-596-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist