Provider Demographics
NPI:1902144264
Name:GEORGE, PEGGY DILLES (PHARMACY DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:DILLES
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHARMACY DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8001
Mailing Address - Country:US
Mailing Address - Phone:813-264-5993
Mailing Address - Fax:813-264-6691
Practice Address - Street 1:3939 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8001
Practice Address - Country:US
Practice Address - Phone:813-264-5993
Practice Address - Fax:813-264-6691
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist