Provider Demographics
NPI:1841468766
Name:KALLINIKOS, STAVROULA
Entity type:Individual
Prefix:
First Name:STAVROULA
Middle Name:
Last Name:KALLINIKOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 147TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3038
Mailing Address - Country:US
Mailing Address - Phone:718-767-0975
Mailing Address - Fax:
Practice Address - Street 1:2136 BARTOW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4615
Practice Address - Country:US
Practice Address - Phone:718-320-2904
Practice Address - Fax:718-379-9565
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist