Provider Demographics
NPI:1972717114
Name:PRATIKAKIS, ATHANASIA N (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ATHANASIA
Middle Name:N
Last Name:PRATIKAKIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ATHANASIA
Other - Middle Name:N
Other - Last Name:ROUMELIOTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7342 W FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-3600
Mailing Address - Country:US
Mailing Address - Phone:773-775-3777
Mailing Address - Fax:773-775-6867
Practice Address - Street 1:7342 W FOSTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-3600
Practice Address - Country:US
Practice Address - Phone:773-775-3777
Practice Address - Fax:773-775-6867
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist