Provider Demographics
NPI:1134424344
Name:WITT, GEORGE LIVINGSTON
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:LIVINGSTON
Last Name:WITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 REED RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-2711
Mailing Address - Country:US
Mailing Address - Phone:713-731-1919
Mailing Address - Fax:713-731-7500
Practice Address - Street 1:4115 REED RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77051-2711
Practice Address - Country:US
Practice Address - Phone:713-731-1919
Practice Address - Fax:713-731-7500
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist