Provider Demographics
NPI:1568951366
Name:FOTENOPULOS, JAMES D (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:FOTENOPULOS
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 1:1924 S UTICA AVE # 416
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6510
Mailing Address - Country:US
Mailing Address - Phone:918-403-4079
Mailing Address - Fax:
Practice Address - Street 1:1924 S UTICA AVE # 416
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6510
Practice Address - Country:US
Practice Address - Phone:918-403-4079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist