Provider Demographics
NPI:1770586174
Name:ANTONOPOULOS, PETE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PETE
Middle Name:
Last Name:ANTONOPOULOS
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 1:125 S JEFFERSON ST
Mailing Address - Street 2:UNIT 2008
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-3738
Mailing Address - Country:US
Mailing Address - Phone:312-864-5726
Mailing Address - Fax:312-864-9287
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:LL 170
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-760-0800
Practice Address - Fax:312-864-9287
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy