Provider Demographics
NPI:1467862862
Name:DIAKANTONIS, SAVA
Entity Type:Individual
Prefix:MR
First Name:SAVA
Middle Name:
Last Name:DIAKANTONIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 MERRIMAN LOOP
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-5212
Mailing Address - Country:US
Mailing Address - Phone:517-552-5246
Mailing Address - Fax:
Practice Address - Street 1:6001 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48383-4302
Practice Address - Country:US
Practice Address - Phone:248-889-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist