Provider Demographics
NPI:1710570445
Name:GEORGE, AUGUSTA (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 IRONSTONE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-8810
Mailing Address - Country:US
Mailing Address - Phone:614-599-2905
Mailing Address - Fax:
Practice Address - Street 1:4241 IRWIN SIMPSON RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9011
Practice Address - Country:US
Practice Address - Phone:614-599-2905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist