Provider Demographics
NPI:1902120223
Name:PANAGOS, KALIOPI (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:KALIOPI
Middle Name:
Last Name:PANAGOS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:KALIOPI
Other - Middle Name:
Other - Last Name:PETRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:5026 OCEANIA ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1123
Mailing Address - Country:US
Mailing Address - Phone:718-598-0548
Mailing Address - Fax:
Practice Address - Street 1:21914 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1923
Practice Address - Country:US
Practice Address - Phone:718-712-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist