Provider Demographics
NPI:1962813683
Name:BASTOUNIS, OURANIA
Entity Type:Individual
Prefix:
First Name:OURANIA
Middle Name:
Last Name:BASTOUNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4998 BROOKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-4200
Mailing Address - Country:US
Mailing Address - Phone:586-747-2993
Mailing Address - Fax:
Practice Address - Street 1:15055 HALL RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-6206
Practice Address - Country:US
Practice Address - Phone:586-566-4133
Practice Address - Fax:586-566-4165
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020294221835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy