Provider Demographics
NPI:1861876385
Name:VASILARAKIS, EMMANUEL N (PHARMD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:N
Last Name:VASILARAKIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:EMMANUEL
Other - Middle Name:N
Other - Last Name:VASILARAKIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1238 PUTTY HILL AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5844
Mailing Address - Country:US
Mailing Address - Phone:410-823-4543
Mailing Address - Fax:
Practice Address - Street 1:1238 PUTTY HILL AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5844
Practice Address - Country:US
Practice Address - Phone:410-823-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23309OtherSTATE OF MARYLAND