Provider Demographics
NPI:1497285902
Name:SPATZ, KRISOULA HORIATES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISOULA
Middle Name:HORIATES
Last Name:SPATZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISOULA
Other - Middle Name:ANGELO
Other - Last Name:HORIATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1275 YORK AVE RM 722
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-5553
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE RM 722
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-16
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI035947001835P0018X
PARP4482631835P0018X
NY0592401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist