Provider Demographics
NPI:1649533779
Name:GEORGE, MATTHEWS
Entity type:Individual
Prefix:MR
First Name:MATTHEWS
Middle Name:
Last Name:GEORGE
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 1:1700 SEASPRAY CT
Mailing Address - Street 2:APT 1159
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3110
Mailing Address - Country:US
Mailing Address - Phone:832-239-5022
Mailing Address - Fax:
Practice Address - Street 1:1700 SEASPRAY CT
Practice Address - Street 2:APT 1159
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3110
Practice Address - Country:US
Practice Address - Phone:832-239-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208529183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician