Provider Demographics
NPI:1104322619
Name:CAPELERIS-TSAGAKIS, ANNA
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:CAPELERIS-TSAGAKIS
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 1:2501 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3413
Mailing Address - Country:US
Mailing Address - Phone:718-721-3650
Mailing Address - Fax:
Practice Address - Street 1:2501 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3413
Practice Address - Country:US
Practice Address - Phone:718-721-3650
Practice Address - Fax:718-721-1220
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist