Provider Demographics
NPI:1104141092
Name:KATERINOPOULOS, EVDOXIA (RPH)
Entity type:Individual
Prefix:MISS
First Name:EVDOXIA
Middle Name:
Last Name:KATERINOPOULOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1640
Mailing Address - Country:US
Mailing Address - Phone:718-428-8793
Mailing Address - Fax:
Practice Address - Street 1:925 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3641
Practice Address - Country:US
Practice Address - Phone:516-328-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist