Provider Demographics
NPI:1336618081
Name:TEBECK, GEORGE NDI (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:NDI
Last Name:TEBECK
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 1:11342 CHERRY HILL RD UNIT 303
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3735
Mailing Address - Country:US
Mailing Address - Phone:240-643-7081
Mailing Address - Fax:
Practice Address - Street 1:165 ORVILLE RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-1309
Practice Address - Country:US
Practice Address - Phone:410-238-1064
Practice Address - Fax:410-238-1869
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD24025OtherPHARMACIST LICENSE