Provider Demographics
NPI:1144567157
Name:KOTRONIS, THOMAS GEORGE
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GEORGE
Last Name:KOTRONIS
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 1:500 EAST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685
Mailing Address - Country:US
Mailing Address - Phone:727-238-3514
Mailing Address - Fax:
Practice Address - Street 1:500 E LAKE RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2428
Practice Address - Country:US
Practice Address - Phone:727-238-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist