Provider Demographics
NPI:1164725461
Name:DEMESTIHAS, PETER IOANNIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:IOANNIS
Last Name:DEMESTIHAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 SHAW FARM RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3441
Mailing Address - Country:US
Mailing Address - Phone:617-504-9022
Mailing Address - Fax:
Practice Address - Street 1:170 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4629
Practice Address - Country:US
Practice Address - Phone:781-963-7713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23242183500000X
RI03876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist