Provider Demographics
NPI:1871638932
Name:KAKATSOS, DIAMANTIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:DIAMANTIS
Middle Name:
Last Name:KAKATSOS
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 1:9330 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5626
Mailing Address - Country:US
Mailing Address - Phone:718-205-5400
Mailing Address - Fax:718-205-5449
Practice Address - Street 1:9330 43RD AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5626
Practice Address - Country:US
Practice Address - Phone:718-205-5400
Practice Address - Fax:718-205-5449
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist