Provider Demographics
NPI:1811286313
Name:POOLE, GEORGE MITCHELL (RPH)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MITCHELL
Last Name:POOLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6228 EASTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-5668
Mailing Address - Country:US
Mailing Address - Phone:205-553-9220
Mailing Address - Fax:
Practice Address - Street 1:2300 MCFARLAND BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-2927
Practice Address - Country:US
Practice Address - Phone:205-339-2700
Practice Address - Fax:205-330-0920
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11216183500000X
MSE07653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist