Provider Demographics
NPI:1780051888
Name:GEORGI, MARIAN (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:GEORGI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75050 FERN CREEK DR
Mailing Address - Street 2:NONE
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-0626
Mailing Address - Country:US
Mailing Address - Phone:904-849-7111
Mailing Address - Fax:
Practice Address - Street 1:5050 EDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3601
Practice Address - Country:US
Practice Address - Phone:904-294-3462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist