Provider Demographics
NPI:1023616711
Name:PRESTON, GEOFFREY DEE (RPH)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:DEE
Last Name:PRESTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14840 OLD TIMBER PASS
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-4000
Mailing Address - Country:US
Mailing Address - Phone:260-438-5416
Mailing Address - Fax:
Practice Address - Street 1:505 TOURING DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2054
Practice Address - Country:US
Practice Address - Phone:260-925-8083
Practice Address - Fax:260-925-9510
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012141A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist