Healthcare Provider Details

I. General information

NPI: 1619962370
Provider Name (Legal Business Name): ELIZABETH KATSACOS SANTA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

IV. Provider business mailing address

7615 BRIGHAM DR
ATLANTA GA
30350-5619
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax: 404-728-4715
Mailing address:
  • Phone: 404-321-6111
  • Fax: 404-728-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS37658
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS37658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: