Provider Demographics
NPI:1790125052
Name:GEORGY, MINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:GEORGY
Suffix:
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 1:71 GADSDEN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1118
Mailing Address - Country:US
Mailing Address - Phone:843-468-1337
Mailing Address - Fax:
Practice Address - Street 1:59 GEORGE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1422
Practice Address - Country:US
Practice Address - Phone:843-720-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist