Provider Demographics
NPI:1932489549
Name:TSIAKOPOULOS, PETER (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:TSIAKOPOULOS
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 1:2401 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1565
Mailing Address - Country:US
Mailing Address - Phone:219-838-1412
Mailing Address - Fax:
Practice Address - Street 1:2401 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1565
Practice Address - Country:US
Practice Address - Phone:219-838-1412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021030A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist