Provider Demographics
NPI:1952616906
Name:KORKOTAS, GEORGIA (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:KORKOTAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2407
Mailing Address - Country:US
Mailing Address - Phone:908-879-2123
Mailing Address - Fax:908-879-3081
Practice Address - Street 1:11 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2407
Practice Address - Country:US
Practice Address - Phone:908-879-2123
Practice Address - Fax:908-879-3081
Is Sole Proprietor?:No
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI25621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist