Provider Demographics
NPI:1225310568
Name:TSAKOS, DIMITRIOS GEORGE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRIOS
Middle Name:GEORGE
Last Name:TSAKOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 CRYSTAL PL
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4076
Mailing Address - Country:US
Mailing Address - Phone:847-356-2066
Mailing Address - Fax:847-356-2194
Practice Address - Street 1:399 SOUTH ROUTE 45
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046
Practice Address - Country:US
Practice Address - Phone:847-356-2066
Practice Address - Fax:847-356-2194
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051.038387OtherSTATE LISCENCE IL