Provider Demographics
NPI:1558544866
Name:PAPPAS, EVANGELOS (RPH)
Entity Type:Individual
Prefix:
First Name:EVANGELOS
Middle Name:
Last Name:PAPPAS
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 1:122 BAY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5052
Mailing Address - Country:US
Mailing Address - Phone:718-333-5979
Mailing Address - Fax:718-333-5983
Practice Address - Street 1:122 BAY RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5052
Practice Address - Country:US
Practice Address - Phone:718-333-5979
Practice Address - Fax:718-333-5983
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04527175Medicaid