Provider Demographics
NPI:1265709265
Name:ANGELOPOULOS, GEORGE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:ANGELOPOULOS
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 1:10 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-886-2844
Mailing Address - Fax:631-886-2842
Practice Address - Street 1:64 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3703
Practice Address - Country:US
Practice Address - Phone:631-663-3800
Practice Address - Fax:631-663-3799
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040973-11835P0018X
NJ040973-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist