Provider Demographics
NPI:1275834343
Name:CHRISTOPOULOS, ATHANASIOS
Entity Type:Individual
Prefix:
First Name:ATHANASIOS
Middle Name:
Last Name:CHRISTOPOULOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:CHRISTOPOULOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5233 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2405
Mailing Address - Country:US
Mailing Address - Phone:773-769-2347
Mailing Address - Fax:
Practice Address - Street 1:5233 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2405
Practice Address - Country:US
Practice Address - Phone:773-769-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.032939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist