Provider Demographics
NPI:1306256789
Name:GEORGE, DONALD MARK (RPH)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MARK
Last Name:GEORGE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 TRACHT DR
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-9331
Mailing Address - Country:US
Mailing Address - Phone:419-468-5842
Mailing Address - Fax:
Practice Address - Street 1:6100 TRACHT DR
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-9331
Practice Address - Country:US
Practice Address - Phone:419-468-5842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH 03213974183500000X
WVRP0003795183500000X
NC14678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA70096099OtherTAX ID NUMBER