Provider Demographics
NPI:1720499569
Name:ANTINOPOULOS, BRANDON CHARLES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:CHARLES
Last Name:ANTINOPOULOS
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 1:807 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:15066-1914
Mailing Address - Country:US
Mailing Address - Phone:724-891-7383
Mailing Address - Fax:724-891-6546
Practice Address - Street 1:807 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:PA
Practice Address - Zip Code:15066-1914
Practice Address - Country:US
Practice Address - Phone:724-891-7383
Practice Address - Fax:724-891-6546
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP448568OtherPENNSYLVANIA PHARMACIST LICENSE