Provider Demographics
NPI:1013131697
Name:TOLIS, ANASTASIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:
Last Name:TOLIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:STATHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:8820 RISING SUN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7941 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2224
Practice Address - Country:US
Practice Address - Phone:215-745-9060
Practice Address - Fax:215-745-0481
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031357L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist