Provider Demographics
NPI:1861678187
Name:PRIOVOLOS, CHRISTINE V
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:V
Last Name:PRIOVOLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1347
Mailing Address - Country:US
Mailing Address - Phone:718-238-7488
Mailing Address - Fax:718-238-7486
Practice Address - Street 1:7115 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1347
Practice Address - Country:US
Practice Address - Phone:718-238-7488
Practice Address - Fax:718-238-7486
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02681354Medicaid