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NPI Code Detail

MEDICARE: DR. IOANNIS KYRIAKOS FOUNTAS PHARMD

MEDICARE: DR. IOANNIS KYRIAKOS FOUNTAS PHARMD
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
1183500000XPharmacist051.301641IL

General Provider Information

NPI Number : 1912472259
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IOANNIS KYRIAKOS FOUNTAS PHARMD
Provider Business Mailing Address
First Line : 370 WOODBINE DR
Second Line :
City : WOOD DALE
State : IL
Zip : 60191-2524
Country : US
Telephone Number : 630-616-0084
Fax Number :
Provider Business Practice Location Address
First Line : 1340 S CANAL ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-5208
Country : US
Telephone Number : 312-666-5612
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2018
Last Update Date : 10/12/2018

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