Provider Demographics
NPI:1699059360
Name:SAKALEROS, ANASTASIOS J
Entity type:Individual
Prefix:MR
First Name:ANASTASIOS
Middle Name:J
Last Name:SAKALEROS
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 1:10795 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7310
Mailing Address - Country:US
Mailing Address - Phone:219-661-8406
Mailing Address - Fax:219-661-8507
Practice Address - Street 1:10795 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7310
Practice Address - Country:US
Practice Address - Phone:219-661-8406
Practice Address - Fax:219-661-8507
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018325A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist