Provider Demographics
NPI:1861118424
Name:TILIAKOS, PANORMITIS JOHN
Entity type:Individual
Prefix:
First Name:PANORMITIS
Middle Name:JOHN
Last Name:TILIAKOS
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 1:600 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9643
Mailing Address - Country:US
Mailing Address - Phone:330-877-0311
Mailing Address - Fax:330-877-0334
Practice Address - Street 1:600 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9643
Practice Address - Country:US
Practice Address - Phone:330-877-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist