Healthcare Provider Details

I. General information

NPI: 1568710895
Provider Name (Legal Business Name): CONSTANTINE DROSSOS CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8318 5TH AVE
BROOKLYN NY
11209-4511
US

IV. Provider business mailing address

8318 5TH AVE
BROOKLYN NY
11209-4511
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number610107010342481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: