Provider Demographics
NPI:1740565548
Name:BOULOS, ELIAS EMILE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:EMILE
Last Name:BOULOS
Suffix:JR
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 1:40 NORTH MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509
Mailing Address - Country:US
Mailing Address - Phone:330-270-5861
Mailing Address - Fax:330-270-8453
Practice Address - Street 1:40 NORTH MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509
Practice Address - Country:US
Practice Address - Phone:330-270-5861
Practice Address - Fax:330-270-8453
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist