Provider Demographics
NPI:1306321922
Name:FOUNTZOULAS, GEORGE (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:FOUNTZOULAS
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 WALMSLEY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4860
Mailing Address - Country:US
Mailing Address - Phone:302-530-9705
Mailing Address - Fax:
Practice Address - Street 1:2719 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3960
Practice Address - Country:US
Practice Address - Phone:302-453-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0005313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist