Provider Demographics
NPI:1093143059
Name:KASOUTO, PAOLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:
Last Name:KASOUTO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2630
Mailing Address - Country:US
Mailing Address - Phone:516-413-6317
Mailing Address - Fax:
Practice Address - Street 1:2 E SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2340
Practice Address - Country:US
Practice Address - Phone:631-234-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist