Provider Demographics
NPI:1568860252
Name:KOTSIDIS-DAKIS, OLGA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:KOTSIDIS-DAKIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 172ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3336
Mailing Address - Country:US
Mailing Address - Phone:718-762-7936
Mailing Address - Fax:
Practice Address - Street 1:4538 172ND ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3336
Practice Address - Country:US
Practice Address - Phone:718-762-7936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043938183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric