Provider Demographics
NPI:1073865549
Name:MAROULIS, NICHOLAS D
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:D
Last Name:MAROULIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5261
Mailing Address - Country:US
Mailing Address - Phone:407-830-8820
Mailing Address - Fax:800-269-5473
Practice Address - Street 1:376 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5261
Practice Address - Country:US
Practice Address - Phone:407-830-8820
Practice Address - Fax:800-269-5473
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 28571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist