Provider Demographics
NPI:1336628569
Name:KEFALOS PHARMACY INC
Entity Type:Organization
Organization Name:KEFALOS PHARMACY INC
Other - Org Name:VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LYMBERATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-476-1881
Mailing Address - Street 1:1227 150TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1747
Mailing Address - Country:US
Mailing Address - Phone:347-732-4772
Mailing Address - Fax:
Practice Address - Street 1:1227A 150TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1747
Practice Address - Country:US
Practice Address - Phone:347-732-4772
Practice Address - Fax:347-732-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057429183500000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty