Provider Demographics
NPI:1053763425
Name:GUIDER, GEORGE
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:GUIDER
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 1:5341 ROCHELLE DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5511
Mailing Address - Country:US
Mailing Address - Phone:330-608-1204
Mailing Address - Fax:
Practice Address - Street 1:6655 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2553
Practice Address - Country:US
Practice Address - Phone:440-428-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-16757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist