Provider Demographics
NPI:1477839645
Name:GIALLOURAKIS, TED GEORGE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:GEORGE
Last Name:GIALLOURAKIS
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 1:4490 PRESTWICK XING
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5068
Mailing Address - Country:US
Mailing Address - Phone:614-406-4616
Mailing Address - Fax:
Practice Address - Street 1:1415 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2701
Practice Address - Country:US
Practice Address - Phone:216-325-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03329040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist