Provider Demographics
NPI:1053951863
Name:GEORGE, MELVIS ANN
Entity type:Individual
Prefix:
First Name:MELVIS
Middle Name:ANN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 CROWN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8306
Mailing Address - Country:US
Mailing Address - Phone:803-554-4245
Mailing Address - Fax:
Practice Address - Street 1:1300 DALLAS CHERRYVILLE HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-8714
Practice Address - Country:US
Practice Address - Phone:704-648-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42376183500000X
NC29132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist