Provider Demographics
NPI:1336429984
Name:PANAGOPOULOS, ANTREA A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ANTREA
Middle Name:A
Last Name:PANAGOPOULOS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4361
Mailing Address - Country:US
Mailing Address - Phone:815-363-0722
Mailing Address - Fax:815-363-6020
Practice Address - Street 1:3925 W ELM ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4361
Practice Address - Country:US
Practice Address - Phone:815-363-0722
Practice Address - Fax:815-363-6020
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-040420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist