Provider Demographics
NPI:1932752060
Name:MAKRICOSTAS, EUGENIA
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:MAKRICOSTAS
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 1:241 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-9615
Mailing Address - Country:US
Mailing Address - Phone:304-670-6467
Mailing Address - Fax:
Practice Address - Street 1:264 S HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2422
Practice Address - Country:US
Practice Address - Phone:740-264-2893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0011675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist