Provider Demographics
NPI:1386824050
Name:ATHANASATOS, JOHN J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:ATHANASATOS
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 1:335 92ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6303
Mailing Address - Country:US
Mailing Address - Phone:718-446-0300
Mailing Address - Fax:
Practice Address - Street 1:7575 31ST AVE
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1811
Practice Address - Country:US
Practice Address - Phone:718-478-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist