Provider Demographics
NPI:1649937939
Name:GEORGE, MERIN NEDUMPILLIL (RPH)
Entity type:Individual
Prefix:
First Name:MERIN
Middle Name:NEDUMPILLIL
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4808
Mailing Address - Country:US
Mailing Address - Phone:516-259-7012
Mailing Address - Fax:
Practice Address - Street 1:3705 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4808
Practice Address - Country:US
Practice Address - Phone:516-259-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-21
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist