Provider Demographics
NPI:1881875003
Name:ANTONOPOULOS, DEMETRIOS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEMETRIOS
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 1:1801 147TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3037
Mailing Address - Country:US
Mailing Address - Phone:718-767-8968
Mailing Address - Fax:
Practice Address - Street 1:19301 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2935
Practice Address - Country:US
Practice Address - Phone:718-357-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist