Provider Demographics
NPI:1619290319
Name:KORGIALAS, KATHY (RPH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:KORGIALAS
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 1:3091 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1974
Mailing Address - Country:US
Mailing Address - Phone:718-626-4600
Mailing Address - Fax:718-626-4626
Practice Address - Street 1:3091 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1974
Practice Address - Country:US
Practice Address - Phone:718-626-4600
Practice Address - Fax:718-626-4626
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042680OtherPHARMACIST LICENSE