Provider Demographics
NPI:1982916136
Name:XENIDIS, DEMETRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEMETRA
Middle Name:
Last Name:XENIDIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WITHERSPOON CT
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08343-2537
Mailing Address - Country:US
Mailing Address - Phone:856-226-3169
Mailing Address - Fax:
Practice Address - Street 1:695 DELSEA DR N
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1447
Practice Address - Country:US
Practice Address - Phone:856-863-0695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-04
Last Update Date:2010-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03023100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist