Provider Demographics
NPI:1366765802
Name:STEFUT, GEORGE MATTHEW (RPH)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MATTHEW
Last Name:STEFUT
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 1:8263 BRIGANTINE CT
Mailing Address - Street 2:APARTMENT 105
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-277-9368
Mailing Address - Fax:
Practice Address - Street 1:10560 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-1944
Practice Address - Country:US
Practice Address - Phone:513-367-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist