Provider Demographics
NPI:1710272604
Name:POULOS, ALEXANDER JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:JAMES
Last Name:POULOS
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 1:588 WATERFORD CIR E
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-7207
Mailing Address - Country:US
Mailing Address - Phone:727-942-1437
Mailing Address - Fax:
Practice Address - Street 1:14134 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1167
Practice Address - Country:US
Practice Address - Phone:727-869-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0033260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist