Provider Demographics
NPI:1871139881
Name:KALTSOUNIS, GEORGIA GLAVAS
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:GLAVAS
Last Name:KALTSOUNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 S LIVERNOIS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6901
Mailing Address - Country:US
Mailing Address - Phone:248-652-4700
Mailing Address - Fax:248-652-1961
Practice Address - Street 1:65 S LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6901
Practice Address - Country:US
Practice Address - Phone:248-652-4700
Practice Address - Fax:248-652-1961
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020326401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist