Provider Demographics
NPI:1609470194
Name:GLAVAS, YIANNIS GEORGE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:YIANNIS
Middle Name:GEORGE
Last Name:GLAVAS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N44W25902 LINDSAY RD
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-1923
Mailing Address - Country:US
Mailing Address - Phone:262-271-4064
Mailing Address - Fax:
Practice Address - Street 1:3900 N 124TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2105
Practice Address - Country:US
Practice Address - Phone:414-847-1101
Practice Address - Fax:414-847-1111
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20336-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist