Provider Demographics
NPI:1740455922
Name:AITAS, ANASTASSIOS T (R PH)
Entity type:Individual
Prefix:
First Name:ANASTASSIOS
Middle Name:T
Last Name:AITAS
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840688
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0688
Mailing Address - Country:US
Mailing Address - Phone:800-255-5967
Mailing Address - Fax:909-799-4364
Practice Address - Street 1:1307 ALLEN DR
Practice Address - Street 2:SUITE H
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4000
Practice Address - Country:US
Practice Address - Phone:800-255-5967
Practice Address - Fax:909-799-4364
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI532029267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist