Provider Demographics
NPI:1992028831
Name:DIAKOGEORGIOS, IRENE (BS)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:DIAKOGEORGIOS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 DITMARS BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2107
Mailing Address - Country:US
Mailing Address - Phone:718-278-3987
Mailing Address - Fax:
Practice Address - Street 1:3518 DITMARS BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2107
Practice Address - Country:US
Practice Address - Phone:718-932-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-07
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist