Provider Demographics
NPI:1497029656
Name:KOTOPOULIS, EVAN G (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:G
Last Name:KOTOPOULIS
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 1:27220 HEATHER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3418
Mailing Address - Country:US
Mailing Address - Phone:949-389-8702
Mailing Address - Fax:949-389-8720
Practice Address - Street 1:27220 HEATHER RIDGE RD
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3418
Practice Address - Country:US
Practice Address - Phone:949-389-8702
Practice Address - Fax:949-389-8720
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist