Provider Demographics
NPI:1063709434
Name:ATTALLA, GEORGE MAGDY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MAGDY
Last Name:ATTALLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SUMMERBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-6728
Mailing Address - Country:US
Mailing Address - Phone:850-228-2633
Mailing Address - Fax:850-894-3239
Practice Address - Street 1:3700 BRADFORDVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-1943
Practice Address - Country:US
Practice Address - Phone:850-894-3239
Practice Address - Fax:850-894-3239
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist