Provider Demographics
NPI:1396772133
Name:KREYTAK, GEORGE EDWARD (PHARMD, CGP)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:KREYTAK
Suffix:
Gender:M
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RUGBY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4015
Mailing Address - Country:US
Mailing Address - Phone:718-720-3608
Mailing Address - Fax:
Practice Address - Street 1:1 RUGBY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4015
Practice Address - Country:US
Practice Address - Phone:718-720-3608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist