Provider Demographics
NPI:1093543357
Name:FATEN&GEORGE, LLC
Entity type:Organization
Organization Name:FATEN&GEORGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAGALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-934-4490
Mailing Address - Street 1:40164 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-8333
Mailing Address - Country:US
Mailing Address - Phone:727-934-4490
Mailing Address - Fax:727-934-4730
Practice Address - Street 1:40164 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-8333
Practice Address - Country:US
Practice Address - Phone:727-934-4490
Practice Address - Fax:727-934-4730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy