MEDICARE: KOSTANTINOS MICHAEL KATSANEVAKIS PHARMD

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	13700	SC

General Provider Information

NPI Number	:	1821340381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOSTANTINOS MICHAEL KATSANEVAKIS PHARMD

Provider Business Mailing Address
First Line	:	150 ASHLEY AVE.
Second Line	:	MSC 584
City	:	CHARLESTON
State	:	SC
Zip	:	29425
Country	:	US
Telephone Number	:	843-876-5585
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 ASHLEY AVE
Second Line	:	MSC 584
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8907
Country	:	US
Telephone Number	:	843-876-5585
Fax Number	:

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

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	10/09/2012

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