Provider Demographics
NPI:1003412545
Name:PITSAKIS, JOHN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:PITSAKIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 AUTUMN LEAF LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1514
Mailing Address - Country:US
Mailing Address - Phone:267-872-7201
Mailing Address - Fax:
Practice Address - Street 1:1785 AUTUMN LEAF LN
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1514
Practice Address - Country:US
Practice Address - Phone:267-872-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist