Provider Demographics
NPI:1144318924
Name:GEORGES, CHANTAL (RPH)
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:
Last Name:GEORGES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NICHOLAS
Mailing Address - Street 2:
Mailing Address - City:LEAMINGTON
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N8H 4R1
Mailing Address - Country:CA
Mailing Address - Phone:519-980-3784
Mailing Address - Fax:
Practice Address - Street 1:4401 CONNER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2201
Practice Address - Country:US
Practice Address - Phone:313-823-9897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist