Provider Demographics
NPI:1154508133
Name:GIANNOUTSOS, CONSTANTINA (RPH)
Entity Type:Individual
Prefix:
First Name:CONSTANTINA
Middle Name:
Last Name:GIANNOUTSOS
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 1:15114 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3104
Mailing Address - Country:US
Mailing Address - Phone:718-746-4534
Mailing Address - Fax:
Practice Address - Street 1:15114 19TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3104
Practice Address - Country:US
Practice Address - Phone:718-746-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038690OtherPHARMACY LICENSE