Provider Demographics
NPI:1669794194
Name:ZISSIS, EVANGELO (PHARMD)
Entity type:Individual
Prefix:MR
First Name:EVANGELO
Middle Name:
Last Name:ZISSIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANGELO
Other - Middle Name:
Other - Last Name:ZISSIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1609 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4153
Mailing Address - Country:US
Mailing Address - Phone:212-772-1110
Mailing Address - Fax:212-772-1112
Practice Address - Street 1:1609 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4153
Practice Address - Country:US
Practice Address - Phone:212-772-1110
Practice Address - Fax:212-772-1112
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist