Provider Demographics
NPI:1942890611
Name:BARKOULAS, THEODORA (PHARMD)
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:
Last Name:BARKOULAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 EDWARDS RD UNIT 59
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1383
Mailing Address - Country:US
Mailing Address - Phone:864-551-8544
Mailing Address - Fax:
Practice Address - Street 1:350 FEASTER RD STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6176
Practice Address - Country:US
Practice Address - Phone:855-240-9368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist