Provider Demographics
NPI:1356968523
Name:MAVROS, GEORGE SAKELLARIOS
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:SAKELLARIOS
Last Name:MAVROS
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 1:17556 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-9371
Mailing Address - Country:US
Mailing Address - Phone:219-791-2082
Mailing Address - Fax:
Practice Address - Street 1:6905 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-2210
Practice Address - Country:US
Practice Address - Phone:219-844-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016965A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist