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General NPI Number Information
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NPI Number | 1336628569
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Entity Type | Organization
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Legal Business Name | KEFALOS PHARMACY INC
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 1227A 150TH ST
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City | WHITESTONE
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State | NY
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Zip | 11357-1747
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Country | US
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Telephone | 347-732-4772
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Fax | 347-732-4532
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Provider Business Mailing Address
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Address Line | 1227 150TH ST
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City | WHITESTONE
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State | NY
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Zip | 11357-1747
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Country | US
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Telephone | 347-732-4772
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Fax |
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | MR. DIMITRIOS LYMBERATOS
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Credential |
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Telephone | 646-476-1881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 057429
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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