Provider Demographics
NPI:1659648327
Name:CONSTANTIN, TASOS JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:TASOS
Middle Name:JOHN
Last Name:CONSTANTIN
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 1:832 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6327
Mailing Address - Country:US
Mailing Address - Phone:408-761-5473
Mailing Address - Fax:
Practice Address - Street 1:1615 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5532
Practice Address - Country:US
Practice Address - Phone:408-978-5393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-24
Last Update Date:2011-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist