Healthcare Provider Details

I. General information

NPI: 1417011248
Provider Name (Legal Business Name): GEORGE D KOLLIAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 E 22ND ST ST VINCENT CHARITY HOSPITAL
CLEVELAND OH
44115-3111
US

IV. Provider business mailing address

32246 DAKOTA RUN
AVON LAKE OH
44012-2610
US

V. Phone/Fax

Practice location:
  • Phone: 216-592-2853
  • Fax: 216-592-2875
Mailing address:
  • Phone: 440-933-3961
  • Fax: 216-592-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03218130
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: