Provider Demographics
NPI:1417238973
Name:SKOKOS, SARANTOS G (PHARMD)
Entity type:Individual
Prefix:
First Name:SARANTOS
Middle Name:G
Last Name:SKOKOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 N WESTRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-5733
Mailing Address - Country:US
Mailing Address - Phone:773-631-2851
Mailing Address - Fax:773-631-3864
Practice Address - Street 1:5753 N CANFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2206
Practice Address - Country:US
Practice Address - Phone:773-631-2851
Practice Address - Fax:773-631-3864
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.2888834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist