Provider Demographics
NPI:1699013904
Name:KOLLIAS, DEMETRI GEORGE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DEMETRI
Middle Name:GEORGE
Last Name:KOLLIAS
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 1:21467 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-3113
Mailing Address - Country:US
Mailing Address - Phone:206-383-6389
Mailing Address - Fax:
Practice Address - Street 1:1100 S MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3428
Practice Address - Country:US
Practice Address - Phone:360-748-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60302915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist