Provider Demographics
NPI:1093037186
Name:VIKATOS, STELLAMARIA (RPH)
Entity Type:Individual
Prefix:
First Name:STELLAMARIA
Middle Name:
Last Name:VIKATOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24933 BEECHKNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1311
Mailing Address - Country:US
Mailing Address - Phone:718-352-5404
Mailing Address - Fax:
Practice Address - Street 1:1229 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5105
Practice Address - Country:US
Practice Address - Phone:212-249-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist