Provider Demographics
NPI:1427812353
Name:VENTESANAKOS, KALIOPE DAMALAS (PHARMD)
Entity type:Individual
Prefix:
First Name:KALIOPE
Middle Name:DAMALAS
Last Name:VENTESANAKOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 73RD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1962
Mailing Address - Country:US
Mailing Address - Phone:646-372-3084
Mailing Address - Fax:
Practice Address - Street 1:970 73RD ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1962
Practice Address - Country:US
Practice Address - Phone:646-372-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03969900183500000X
NY067435-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist