Provider Demographics
NPI:1124346895
Name:GEORGE, SHEEJU
Entity type:Individual
Prefix:
First Name:SHEEJU
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 OAK LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-3611
Mailing Address - Country:US
Mailing Address - Phone:732-589-9700
Mailing Address - Fax:
Practice Address - Street 1:4125 S BROAD ST
Practice Address - Street 2:
Practice Address - City:YARDVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08620-2001
Practice Address - Country:US
Practice Address - Phone:609-585-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02935000183500000X
TX43245183500000X
NY047846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist