Provider Demographics
NPI:1669795589
Name:MITSOPOULOS, GEORGE APOSTOLOS (RPH)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:APOSTOLOS
Last Name:MITSOPOULOS
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 1:2202 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3648
Mailing Address - Country:US
Mailing Address - Phone:718-368-3900
Mailing Address - Fax:718-368-1818
Practice Address - Street 1:2202 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3648
Practice Address - Country:US
Practice Address - Phone:718-368-3900
Practice Address - Fax:718-368-1818
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041206OtherPHARMACIST LICENSE