Provider Demographics
NPI:1669759585
Name:GIARRUSSO, GEORGE (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:GIARRUSSO
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 HORSESHOE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-7100
Mailing Address - Country:US
Mailing Address - Phone:951-681-8442
Mailing Address - Fax:951-681-8442
Practice Address - Street 1:8044 LIMONITE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-6107
Practice Address - Country:US
Practice Address - Phone:951-685-0139
Practice Address - Fax:951-685-0154
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH36573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH36573OtherCALIFORNIA BOARD OF PHARMACY LICENSE NUMBER