Provider Demographics
NPI:1427720929
Name:GEORGY, SHADY GERGES ESHAK
Entity type:Individual
Prefix:
First Name:SHADY
Middle Name:GERGES ESHAK
Last Name:GEORGY
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 1:1495 BALHAN DR APT 206
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3772
Mailing Address - Country:US
Mailing Address - Phone:925-214-8155
Mailing Address - Fax:
Practice Address - Street 1:1495 BALHAN DR APT 206
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3772
Practice Address - Country:US
Practice Address - Phone:925-214-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist