Provider Demographics
NPI:1104148931
Name:SALOUROS, ANASTASIA
Entity type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:
Last Name:SALOUROS
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 1:3124 35TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1578
Mailing Address - Country:US
Mailing Address - Phone:718-255-6519
Mailing Address - Fax:
Practice Address - Street 1:3124 35TH ST
Practice Address - Street 2:APT# 1B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1578
Practice Address - Country:US
Practice Address - Phone:718-255-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist