Provider Demographics
NPI:1982873840
Name:ANTIARIS, ANNA G
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:G
Last Name:ANTIARIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ANTIARIS
Other - Last Name:PANOPOULOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:16004 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2713
Mailing Address - Country:US
Mailing Address - Phone:718-767-2447
Mailing Address - Fax:
Practice Address - Street 1:1757 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-2828
Practice Address - Country:US
Practice Address - Phone:914-961-2355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041645183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy