Provider Demographics
NPI:1689289407
Name:PANAGAKIS, NADINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:
Last Name:PANAGAKIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081
Mailing Address - Country:US
Mailing Address - Phone:815-675-6984
Mailing Address - Fax:
Practice Address - Street 1:2401 ROUTE 12
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081
Practice Address - Country:US
Practice Address - Phone:815-675-6984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.299729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist