Healthcare Provider Details

I. General information

NPI: 1326225996
Provider Name (Legal Business Name): MARIA K SKOUPAS PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2008
Last Update Date: 01/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24224 NORTHERN BLVD
DOUGLASTON NY
11362-1143
US

IV. Provider business mailing address

24224 NORTHERN BLVD
DOUGLASTON NY
11362-1143
US

V. Phone/Fax

Practice location:
  • Phone: 718-225-0864
  • Fax: 718-225-5879
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: