Healthcare Provider Details

I. General information

NPI: 1386764256
Provider Name (Legal Business Name): ELENI ANGELOPOULOS-MICHAEL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15365 CROSS ISLAND PKWY
WHITESTONE NY
11357-2648
US

IV. Provider business mailing address

14565 20TH AVE
WHITESTONE NY
11357-3032
US

V. Phone/Fax

Practice location:
  • Phone: 718-767-6000
  • Fax:
Mailing address:
  • Phone: 718-357-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046898
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: