Provider Demographics
NPI:1336327097
Name:PAPOUTSAKIS, FOTI (RPH)
Entity Type:Individual
Prefix:
First Name:FOTI
Middle Name:
Last Name:PAPOUTSAKIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2714
Mailing Address - Country:US
Mailing Address - Phone:718-204-5511
Mailing Address - Fax:718-204-1629
Practice Address - Street 1:2208 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2714
Practice Address - Country:US
Practice Address - Phone:718-204-5511
Practice Address - Fax:718-204-1629
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044895-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01776425Medicaid