Provider Demographics
NPI:1609160332
Name:YIANNOS, DIMITRA S (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIMITRA
Middle Name:S
Last Name:YIANNOS
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 1:325 PEARL HILL RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-2057
Mailing Address - Country:US
Mailing Address - Phone:978-345-7337
Mailing Address - Fax:
Practice Address - Street 1:52 PEARSON BLVD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3947
Practice Address - Country:US
Practice Address - Phone:978-632-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist