Provider Demographics
NPI:1457956443
Name:KANELLOS, SPIRO ANDREAS
Entity Type:Individual
Prefix:
First Name:SPIRO
Middle Name:ANDREAS
Last Name:KANELLOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 GORHAM ST APT 43
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-5249
Mailing Address - Country:US
Mailing Address - Phone:978-996-3497
Mailing Address - Fax:
Practice Address - Street 1:501 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3335
Practice Address - Country:US
Practice Address - Phone:978-443-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist