Provider Demographics
NPI:1902086820
Name:XANTHOPOULOS, ANDREAS P (PHARM D, RPH)
Entity Type:Individual
Prefix:MR
First Name:ANDREAS
Middle Name:P
Last Name:XANTHOPOULOS
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2808
Mailing Address - Country:US
Mailing Address - Phone:718-829-6808
Mailing Address - Fax:718-829-6236
Practice Address - Street 1:2748 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2808
Practice Address - Country:US
Practice Address - Phone:718-829-6808
Practice Address - Fax:718-829-6236
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02496986Medicaid