Provider Demographics
NPI:1477763084
Name:POULATHAS, MARIA IRENE COKONIS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:IRENE COKONIS
Last Name:POULATHAS
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 1:223 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3505
Mailing Address - Country:US
Mailing Address - Phone:856-222-0697
Mailing Address - Fax:
Practice Address - Street 1:223 HIGH ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3505
Practice Address - Country:US
Practice Address - Phone:856-222-0697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043690L183500000X
NJ6814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist