Provider Demographics
NPI:1407135916
Name:PIKOULAS, THEODORE EVAN (PHARMD, BCPP)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:EVAN
Last Name:PIKOULAS
Suffix:
Gender:M
Credentials:PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 REXWOODS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3357
Mailing Address - Country:US
Mailing Address - Phone:919-745-2387
Mailing Address - Fax:919-745-2352
Practice Address - Street 1:2300 REXWOODS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3357
Practice Address - Country:US
Practice Address - Phone:919-745-2387
Practice Address - Fax:919-745-2352
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist