Provider Demographics
NPI:1811439870
Name:ST GEORGE PHARMACEUTICAL INC
Entity type:Organization
Organization Name:ST GEORGE PHARMACEUTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EBRAM TAWDROUS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWDROUS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:559-274-3234
Mailing Address - Street 1:873 E MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2246
Mailing Address - Country:US
Mailing Address - Phone:559-556-6014
Mailing Address - Fax:559-556-6051
Practice Address - Street 1:873 E MERRITT AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2246
Practice Address - Country:US
Practice Address - Phone:559-556-6014
Practice Address - Fax:559-556-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA554313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167927OtherPK