Provider Demographics
NPI:1043487689
Name:MANESSIS-KALOUDIS, MADELINE MARIA (RPH)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:MARIA
Last Name:MANESSIS-KALOUDIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:MARIA
Other - Last Name:MANESSIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:507 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6305
Mailing Address - Country:US
Mailing Address - Phone:914-576-0100
Mailing Address - Fax:914-576-7391
Practice Address - Street 1:507 MAIN ST
Practice Address - Street 2:MAIN ST APOTHECARY & SURGICAL
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6305
Practice Address - Country:US
Practice Address - Phone:914-576-0100
Practice Address - Fax:914-576-7391
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist