Provider Demographics
NPI:1457674590
Name:ANDRIOTIS, NIKITAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:NIKITAS
Middle Name:
Last Name:ANDRIOTIS
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 1:21302 42ND AVE
Mailing Address - Street 2:APT 3A
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2824
Mailing Address - Country:US
Mailing Address - Phone:516-965-0509
Mailing Address - Fax:
Practice Address - Street 1:21302 42ND AVE
Practice Address - Street 2:APT 3A
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2824
Practice Address - Country:US
Practice Address - Phone:516-965-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist