Basic Information
| Provider Information | |||||||||
| NPI: | 1700874070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOLSKEY | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | HALL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 SE PINE DR | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320256887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867528876 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 619 S MARION AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320255808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
| FaxNumber: | 3867546306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 12178 | FL | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
ID Information
| ID | Type | State | Issuer | Description | 12178 | 01 | FL | PHARMACIST LIS | OTHER |