Provider Demographics
NPI:1679896963
Name:KONSTANTINAKOS, ATHENA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:
Last Name:KONSTANTINAKOS
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 1:94 FRANKEL RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7261
Mailing Address - Country:US
Mailing Address - Phone:516-867-6260
Mailing Address - Fax:
Practice Address - Street 1:668 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3136
Practice Address - Country:US
Practice Address - Phone:516-867-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist