Provider Demographics
NPI:1609407386
Name:ATHNASIOS, CAROLINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:ATHNASIOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 TRACEKY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3590
Mailing Address - Country:US
Mailing Address - Phone:586-925-0272
Mailing Address - Fax:
Practice Address - Street 1:1462 TRACEKY
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306-3590
Practice Address - Country:US
Practice Address - Phone:586-925-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist