Provider Demographics
NPI:1053541094
Name:DEMESTIHAS, PANTELIS (RPH, MS)
Entity type:Individual
Prefix:MR
First Name:PANTELIS
Middle Name:
Last Name:DEMESTIHAS
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:MR
Other - First Name:TELLY
Other - Middle Name:
Other - Last Name:DEMESTIHAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH,MS
Mailing Address - Street 1:239 UNITY RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4932
Mailing Address - Country:US
Mailing Address - Phone:203-380-2923
Mailing Address - Fax:
Practice Address - Street 1:239 UNITY RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4932
Practice Address - Country:US
Practice Address - Phone:203-380-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0010714183500000X
NY043114-1183500000X
NJ28RI01998900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist