Provider Demographics
NPI:1831413954
Name:NEKOS, PETER GEORGE (RPH)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:GEORGE
Last Name:NEKOS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:GEORGE
Other - Last Name:NEKOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:4103 STATE RT 28
Mailing Address - Street 2:BX 474
Mailing Address - City:BOICEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12412-0474
Mailing Address - Country:US
Mailing Address - Phone:845-651-6511
Mailing Address - Fax:845-657-9854
Practice Address - Street 1:4103 STATE RT 28
Practice Address - Street 2:474
Practice Address - City:BOICEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12412-0474
Practice Address - Country:US
Practice Address - Phone:845-657-6511
Practice Address - Fax:854-757-9854
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist