Provider Demographics
NPI:1871771956
Name:VASOU, CHRISTOS M (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTOS
Middle Name:M
Last Name:VASOU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12387 YELLOW BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2025
Mailing Address - Country:US
Mailing Address - Phone:904-751-2744
Mailing Address - Fax:904-751-7524
Practice Address - Street 1:12387 YELLOW BLUFF RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2025
Practice Address - Country:US
Practice Address - Phone:954-751-2744
Practice Address - Fax:904-751-7524
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44635183500000X
NY041027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist