Healthcare Provider Details

I. General information

NPI: 1477148872
Provider Name (Legal Business Name): EFROSINI LIAKOPOULOS KOUTOURATSAS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EFROSINI LIAKOPOULOS

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BELL BLVD
BAYSIDE NY
11361-2061
US

IV. Provider business mailing address

3920 BELL BLVD
BAYSIDE NY
11361-2061
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-2606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberI045170
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI045170
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: