Provider Demographics
NPI:1477879724
Name:DOUKAS, OLGA (RPH)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:DOUKAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:DOUKAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:7316 174TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1425
Mailing Address - Country:US
Mailing Address - Phone:718-591-1275
Mailing Address - Fax:
Practice Address - Street 1:1502 ELM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5217
Practice Address - Country:US
Practice Address - Phone:718-339-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00932018Medicaid