Provider Demographics
NPI:1730475567
Name:GEORGE, AQUILINA
Entity Type:Individual
Prefix:MRS
First Name:AQUILINA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 PARK ST N
Mailing Address - Street 2:T-1023
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4020
Mailing Address - Country:US
Mailing Address - Phone:727-541-3930
Mailing Address - Fax:727-541-3930
Practice Address - Street 1:4450 PARK ST N
Practice Address - Street 2:T-1023
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4020
Practice Address - Country:US
Practice Address - Phone:727-541-3930
Practice Address - Fax:727-541-3930
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 30705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist