Provider Demographics
NPI:1376991455
Name:KATSETOS, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KATSETOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3807
Mailing Address - Country:US
Mailing Address - Phone:203-541-3972
Mailing Address - Fax:203-602-5526
Practice Address - Street 1:66 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3807
Practice Address - Country:US
Practice Address - Phone:203-541-3972
Practice Address - Fax:203-602-5526
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-30
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0012307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist