Provider Demographics
NPI:1477148872
Name:LIAKOPOULOS KOUTOURATSAS, EFROSINI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:EFROSINI
Middle Name:
Last Name:LIAKOPOULOS KOUTOURATSAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:EFROSINI
Other - Middle Name:
Other - Last Name:LIAKOPOULOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3920 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3920 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2061
Practice Address - Country:US
Practice Address - Phone:718-224-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI0451701835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist