Provider Demographics
NPI:1790078970
Name:DEGEORGE, ARTHUR L (RPH)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:L
Last Name:DEGEORGE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3027
Mailing Address - Country:US
Mailing Address - Phone:330-477-7269
Mailing Address - Fax:330-479-0821
Practice Address - Street 1:3010 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3027
Practice Address - Country:US
Practice Address - Phone:330-477-7269
Practice Address - Fax:330-479-0821
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03310630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist