MEDICARE: MR. PETER TSIAKOPOULOS RPH

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
1	183500000X	Pharmacist	26021030A	IN

General Provider Information

NPI Number	:	1932489549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER TSIAKOPOULOS RPH

Provider Business Mailing Address
First Line	:	2401 RIDGE RD
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-1565
Country	:	US
Telephone Number	:	219-838-1412
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 RIDGE RD
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-1565
Country	:	US
Telephone Number	:	219-838-1412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2011
Last Update Date	:	01/27/2012

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