Provider Demographics
NPI:1063628949
Name:KAVRAZONIS, ALEX (RPH)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:KAVRAZONIS
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 1:109 POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1407
Mailing Address - Country:US
Mailing Address - Phone:516-333-0231
Mailing Address - Fax:
Practice Address - Street 1:109 POST RD
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1407
Practice Address - Country:US
Practice Address - Phone:516-333-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist