Provider Demographics
NPI:1417011248
Name:KOLLIAS, GEORGE D (RPH)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:D
Last Name:KOLLIAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32246 DAKOTA RUN
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2610
Mailing Address - Country:US
Mailing Address - Phone:440-933-3961
Mailing Address - Fax:216-592-2875
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:ST VINCENT CHARITY HOSPITAL
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-592-2853
Practice Address - Fax:216-592-2875
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03218130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7649709Medicaid
OHFV94211OtherFLU VACCINE MEDICARE PIN
OH360037Medicare ID - Type Unspecified