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General NPI Number Information
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NPI Number | 1609470194
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Entity Type | Individual
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Provider Name | YIANNIS GEORGE GLAVAS PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 3900 N 124TH ST
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City | WAUWATOSA
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State | WI
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Zip | 53222-2105
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Country | US
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Telephone | 414-847-1101
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Fax | 414-847-1111
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Provider Business Mailing Address
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Address Line | N44W25902 LINDSAY RD
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City | PEWAUKEE
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State | WI
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Zip | 53072-1923
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Country | US
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Telephone | 262-271-4064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 20336-40
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License Number State | WI
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