Provider Demographics
NPI:1649612789
Name:KOUTROULAKIS, EMILY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:KOUTROULAKIS
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 1:2604 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-2489
Mailing Address - Country:US
Mailing Address - Phone:706-798-5645
Mailing Address - Fax:706-798-0377
Practice Address - Street 1:2604 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-2489
Practice Address - Country:US
Practice Address - Phone:706-798-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14218183500000X
VA0202212216183500000X
GARPH029652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist