Provider Demographics
NPI:1285757062
Name:KOURETSOS, CHRISTOS (PPH MS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOS
Middle Name:
Last Name:KOURETSOS
Suffix:
Gender:M
Credentials:PPH MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 6TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3320
Mailing Address - Country:US
Mailing Address - Phone:718-833-1368
Mailing Address - Fax:718-833-1368
Practice Address - Street 1:699 92ND STREET
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228
Practice Address - Country:US
Practice Address - Phone:718-567-1466
Practice Address - Fax:718-567-1348
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist