Provider Demographics
NPI:1821340381
Name:KATSANEVAKIS, KOSTANTINOS MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:KOSTANTINOS
Middle Name:MICHAEL
Last Name:KATSANEVAKIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ASHLEY AVE.
Mailing Address - Street 2:MSC 584
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425
Mailing Address - Country:US
Mailing Address - Phone:843-876-5585
Mailing Address - Fax:
Practice Address - Street 1:150 ASHLEY AVE
Practice Address - Street 2:MSC 584
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8907
Practice Address - Country:US
Practice Address - Phone:843-876-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist