Provider Demographics
NPI:1275856635
Name:VARSOU, KONSTANTINA PASSALARIS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KONSTANTINA
Middle Name:PASSALARIS
Last Name:VARSOU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:KONSTANTINA
Other - Middle Name:
Other - Last Name:VARSOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:500 E SANDFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4750
Mailing Address - Country:US
Mailing Address - Phone:914-530-3001
Mailing Address - Fax:914-530-3001
Practice Address - Street 1:500 E SANDFORD BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4750
Practice Address - Country:US
Practice Address - Phone:914-530-3001
Practice Address - Fax:914-530-3001
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist