Provider Demographics
NPI:1720219868
Name:GEORGE, COSMOS NELO II (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:COSMOS
Middle Name:NELO
Last Name:GEORGE
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23628 LONDON CT # 1512
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3314
Mailing Address - Country:US
Mailing Address - Phone:313-549-3500
Mailing Address - Fax:
Practice Address - Street 1:1900 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1008
Practice Address - Country:US
Practice Address - Phone:313-892-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020322271835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy