Provider Demographics
NPI:1477736924
Name:GOULIMIS-POULOS, EVRIDIKI VICKI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:EVRIDIKI
Middle Name:VICKI
Last Name:GOULIMIS-POULOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1741
Mailing Address - Country:US
Mailing Address - Phone:718-639-2647
Mailing Address - Fax:718-592-0799
Practice Address - Street 1:3706 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11368-1741
Practice Address - Country:US
Practice Address - Phone:718-639-2647
Practice Address - Fax:718-592-0799
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477036Medicaid