Provider Demographics
NPI:1467639559
Name:NADZAN, ATHENA LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:LOUISE
Last Name:NADZAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:LOUISE
Other - Last Name:KYPRIANOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3420 DAVIDSBURG RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-4555
Mailing Address - Country:US
Mailing Address - Phone:717-467-0177
Mailing Address - Fax:
Practice Address - Street 1:3420 DAVIDSBURG RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-4555
Practice Address - Country:US
Practice Address - Phone:717-467-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist