Provider Demographics
NPI:1124395314
Name:KATSIKIS, STAMATIOS LEONIDAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:STAMATIOS
Middle Name:LEONIDAS
Last Name:KATSIKIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:LEONIDAS
Other - Last Name:KATSIKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:307 ROUTE 70 W
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1692
Mailing Address - Country:US
Mailing Address - Phone:856-983-3665
Mailing Address - Fax:
Practice Address - Street 1:307 ROUTE 70 W
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1692
Practice Address - Country:US
Practice Address - Phone:856-983-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO3149100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist