Provider Demographics
NPI:1134150535
Name:STAGG, GEORGE MICHAEL (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:STAGG
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1630
Mailing Address - Country:US
Mailing Address - Phone:973-697-4169
Mailing Address - Fax:
Practice Address - Street 1:1481 ROUTE 23
Practice Address - Street 2:SUITE 3
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-1645
Practice Address - Country:US
Practice Address - Phone:973-492-5400
Practice Address - Fax:973-492-0099
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01728000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist