Provider Demographics
NPI:1376726836
Name:ANTIMISIARIS, DEMETRA ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRA
Middle Name:ELIZABETH
Last Name:ANTIMISIARIS
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Gender:F
Credentials:PHARMD
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Mailing Address - Street 1:501 E BROADWAY STE 204
Mailing Address - Street 2:UNIV. OF LOUISVILLE:DEPT. OF FAMILY & GERIATRIC MED
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-852-2813
Mailing Address - Fax:502-852-0415
Practice Address - Street 1:501 E BROADWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1785
Practice Address - Country:US
Practice Address - Phone:502-852-2813
Practice Address - Fax:502-852-0415
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
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Provider Licenses
StateLicense IDTaxonomies
KY0138721835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric