Provider Demographics
NPI:1164903639
Name:KOMBAKIS, PETER (PHD PHARMACY)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:KOMBAKIS
Suffix:
Gender:M
Credentials:PHD PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 RAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 RAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4320
Practice Address - Country:US
Practice Address - Phone:207-776-8452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4248183500000X
MEPR46181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH4248OtherNH STATE PHARMACY LICENSE
MEPR46181OtherMAINE STATE PHARMACY LICENSE