Provider Demographics
NPI:1538532775
Name:BOUCHEBL, GEORGE
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BOUCHEBL
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 1:12907 DOVE OAKS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-4242
Mailing Address - Country:US
Mailing Address - Phone:281-964-6694
Mailing Address - Fax:281-446-3671
Practice Address - Street 1:18839 MCKAY DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5721
Practice Address - Country:US
Practice Address - Phone:281-964-6634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist