MEDICARE: DR. KONSTANTINA KROKOS

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
1	183500000X	Pharmacist	049070	NY

General Provider Information

NPI Number	:	1326283524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KONSTANTINA KROKOS

Provider Business Mailing Address
First Line	:	6502-6510 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204
Country	:	US
Telephone Number	:	718-331-4580
Fax Number	:

Provider Business Practice Location Address
First Line	:	6502-6510 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204
Country	:	US
Telephone Number	:	718-331-4580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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