Provider Demographics
NPI:1891078150
Name:TSOUPRAKOS, XENOPHON G (RPH)
Entity Type:Individual
Prefix:MR
First Name:XENOPHON
Middle Name:G
Last Name:TSOUPRAKOS
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 1:125 BEACON DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4309
Mailing Address - Country:US
Mailing Address - Phone:631-244-8676
Mailing Address - Fax:631-589-6672
Practice Address - Street 1:125 BEACON DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4309
Practice Address - Country:US
Practice Address - Phone:631-244-8676
Practice Address - Fax:631-589-6672
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI037907-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist