Provider Demographics
NPI:1790098176
Name:ANDERSON, GEORGE PHILLIP (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PHILLIP
Last Name:ANDERSON
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 1:175 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15314-1027
Mailing Address - Country:US
Mailing Address - Phone:724-239-3400
Mailing Address - Fax:724-239-2323
Practice Address - Street 1:175 WILSON RD
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314-1027
Practice Address - Country:US
Practice Address - Phone:724-239-3400
Practice Address - Fax:724-239-2323
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038088L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist