Provider Demographics
NPI:1689857047
Name:ANTHOULIS, POPI (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:POPI
Middle Name:
Last Name:ANTHOULIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:POPI
Other - Middle Name:
Other - Last Name:ANTHOULIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3823 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2012
Mailing Address - Country:US
Mailing Address - Phone:718-743-8933
Mailing Address - Fax:
Practice Address - Street 1:3823 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2012
Practice Address - Country:US
Practice Address - Phone:718-743-8933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01562490Medicaid