Provider Demographics
NPI:1194573303
Name:KATOS, PETER MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:KATOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S HAWTHORNE RD APT 5
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3758
Mailing Address - Country:US
Mailing Address - Phone:704-881-1406
Mailing Address - Fax:
Practice Address - Street 1:2758 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27263-1939
Practice Address - Country:US
Practice Address - Phone:336-861-2062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist