Provider Demographics
NPI:1508247511
Name:KIRIAKOS, MONA
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:KIRIAKOS
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 1:1923 CEDAR FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4147
Mailing Address - Country:US
Mailing Address - Phone:925-951-7992
Mailing Address - Fax:
Practice Address - Street 1:1923 CEDAR FALLS AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4147
Practice Address - Country:US
Practice Address - Phone:925-951-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist