Provider Demographics
NPI:1154541902
Name:BAROODY, GEORGES
Entity type:Individual
Prefix:
First Name:GEORGES
Middle Name:
Last Name:BAROODY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COOPER ST
Mailing Address - Street 2:APT 6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2310
Mailing Address - Country:US
Mailing Address - Phone:212-569-3952
Mailing Address - Fax:212-569-3952
Practice Address - Street 1:4910 BROADWAY
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034
Practice Address - Country:US
Practice Address - Phone:212-569-2512
Practice Address - Fax:646-796-9839
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist