Provider Demographics
NPI:1700658044
Name:LIANDRIS, EVANTHIA SOPHIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVANTHIA
Middle Name:SOPHIA
Last Name:LIANDRIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 43RD ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2553
Mailing Address - Country:US
Mailing Address - Phone:917-617-0144
Mailing Address - Fax:
Practice Address - Street 1:129 FULTON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2716
Practice Address - Country:US
Practice Address - Phone:212-233-5021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist