Derek Wayne George, PHARMD
Individual provider Active NPI Pharmacist · Riverside, MO
NPI 1770925638 · NPPES record last updated Oct 14, 2021
Key facts
- NPI
- 1770925638
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2013022767 (MO)
- Practice address
- 4526 NW Rossella CT
Riverside, MO 64150-7826 - Phone
- (425) 305-8747
- NPI assigned
- Jul 20, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2013022767 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2013022767 | MO | Yes |
Addresses
Primary practice location
4526 NW Rossella CT
Riverside, MO 64150-7826
Mailing address
4526 NW Rossella CT
Riverside, MO 64150-7826
Phone (425) 305-8747
Other providers in Riverside, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.