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NPI Code Detail

MEDICARE: DIMITRIOS SOTIRIOS BAKOLAS

MEDICARE: DIMITRIOS SOTIRIOS BAKOLAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPH236236MA

General Provider Information

NPI Number : 1811365885
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIMITRIOS SOTIRIOS BAKOLAS
Provider Business Mailing Address
First Line : 2150 PROVIDENCE HWY
Second Line :
City : WALPOLE
State : MA
Zip : 02081-2525
Country : US
Telephone Number : 617-325-0017
Fax Number :
Provider Business Practice Location Address
First Line : 825 MORTON ST
Second Line :
City : MATTAPAN
State : MA
Zip : 02126-1850
Country : US
Telephone Number : 617-298-3114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2015
Last Update Date : 06/08/2022

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Directions to “ DIMITRIOS SOTIRIOS BAKOLAS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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