Provider Demographics
NPI:1164779799
Name:ANTONOPOULOS, ALEX (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:ANTONOPOULOS
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 1:32-50 VERNON BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11106
Mailing Address - Country:US
Mailing Address - Phone:718-267-5516
Mailing Address - Fax:718-267-3693
Practice Address - Street 1:32-50 VERNON BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11106
Practice Address - Country:US
Practice Address - Phone:718-267-5516
Practice Address - Fax:718-267-3693
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist