Provider Demographics
NPI:1285879973
Name:LEGAKIS, NICKY N (R,PH)
Entity type:Individual
Prefix:MR
First Name:NICKY
Middle Name:N
Last Name:LEGAKIS
Suffix:
Gender:M
Credentials:R,PH
Other - Prefix:MR
Other - First Name:NICKY
Other - Middle Name:N
Other - Last Name:LEGAKIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:668 84TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228
Mailing Address - Country:US
Mailing Address - Phone:718-745-2215
Mailing Address - Fax:
Practice Address - Street 1:668 84TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228
Practice Address - Country:US
Practice Address - Phone:718-745-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist