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General NPI Number Information
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NPI Number | 1811365885
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Entity Type | Individual
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Provider Name | DIMITRIOS SOTIRIOS BAKOLAS
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Gender | Male
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 825 MORTON ST
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City | MATTAPAN
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State | MA
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Zip | 02126-1850
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Country | US
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Telephone | 617-298-3114
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 PROVIDENCE HWY
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City | WALPOLE
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State | MA
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Zip | 02081-2525
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Country | US
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Telephone | 617-325-0017
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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 | PH236236
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License Number State | MA
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