Provider Demographics
NPI:1679823959
Name:BLETSIS, VASILIOS (RPH)
Entity Type:Individual
Prefix:
First Name:VASILIOS
Middle Name:
Last Name:BLETSIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 DANIEL WEBSTER HWY
Mailing Address - Street 2:TARGET PHARMACY 1228
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-5730
Mailing Address - Country:US
Mailing Address - Phone:603-891-4869
Mailing Address - Fax:
Practice Address - Street 1:310 DANIEL WEBSTER HWY
Practice Address - Street 2:TARGET PHARMACY 1228
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5730
Practice Address - Country:US
Practice Address - Phone:603-891-4869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3258183500000X
MAPH24421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist