Provider Demographics
NPI:1730462946
Name:QADIR, GEORGIA (RPH)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:
Last Name:QADIR
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 1:195 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1969
Mailing Address - Country:US
Mailing Address - Phone:203-262-1724
Mailing Address - Fax:
Practice Address - Street 1:20 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2302
Practice Address - Country:US
Practice Address - Phone:203-753-1116
Practice Address - Fax:203-753-1117
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist