Provider Demographics
NPI:1699934513
Name:ISAAKIDIS, GEORGE (RPH)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:ISAAKIDIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 150TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1752
Mailing Address - Country:US
Mailing Address - Phone:718-767-7868
Mailing Address - Fax:718-767-5600
Practice Address - Street 1:1265 150TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1752
Practice Address - Country:US
Practice Address - Phone:718-767-7868
Practice Address - Fax:718-767-5600
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY043968OtherNY LIC