Provider Demographics
NPI:1831668664
Name:BALTATZIDIS, EMMANUEL ANGELO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:ANGELO
Last Name:BALTATZIDIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 N READING RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1652
Mailing Address - Country:US
Mailing Address - Phone:717-733-4052
Mailing Address - Fax:717-738-0475
Practice Address - Street 1:331 N READING RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1652
Practice Address - Country:US
Practice Address - Phone:717-733-4052
Practice Address - Fax:717-738-0475
Is Sole Proprietor?:No
Enumeration Date:2018-11-22
Last Update Date:2018-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist