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NPI Code Detail

MEDICARE: KONSTANTINA VERVENIOTIS II

MEDICARE: KONSTANTINA VERVENIOTIS II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist038253NY

General Provider Information

NPI Number : 1104148576
Entity Type Code : Individual
Provider Name (Legal Business Name) : KONSTANTINA VERVENIOTIS II
Provider Business Mailing Address
First Line : 1721 AVENUE U
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-3811
Country : US
Telephone Number : 718-645-8565
Fax Number : 718-645-8271
Provider Business Practice Location Address
First Line : 1721 AVENUE U
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-3811
Country : US
Telephone Number : 718-645-8565
Fax Number : 718-645-8271
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2010
Last Update Date : 02/25/2010

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Directions to “ KONSTANTINA VERVENIOTIS II ” Practice Location

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