Provider Demographics
NPI:1760649339
Name:BASTOUNIS, DIMITRIOS (RPH)
Entity Type:Individual
Prefix:MR
First Name:DIMITRIOS
Middle Name:
Last Name:BASTOUNIS
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 1:17370 SHINNECOCK DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-1147
Mailing Address - Country:US
Mailing Address - Phone:586-764-5983
Mailing Address - Fax:
Practice Address - Street 1:7887 26 MILE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48094-3820
Practice Address - Country:US
Practice Address - Phone:586-677-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist