Provider Demographics
NPI:1730364050
Name:DARIOTIS, GEORGE JOHN
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JOHN
Last Name:DARIOTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24632 VAN ZANDT AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1239
Mailing Address - Country:US
Mailing Address - Phone:718-926-5674
Mailing Address - Fax:
Practice Address - Street 1:3920 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2061
Practice Address - Country:US
Practice Address - Phone:718-224-2606
Practice Address - Fax:718-224-8083
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist