Provider Demographics
NPI:1285239079
Name:GDOVIN, GEORGE E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:GDOVIN
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 1:69 APPLETREE RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2228
Mailing Address - Country:US
Mailing Address - Phone:908-770-8616
Mailing Address - Fax:
Practice Address - Street 1:71 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-7136
Practice Address - Country:US
Practice Address - Phone:732-222-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01692200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist