Healthcare Provider Details

I. General information

NPI: 1164620365
Provider Name (Legal Business Name): CHRIS PANAGOS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 TALL PINES DR STE 118
LARGO FL
33771-5318
US

IV. Provider business mailing address

4897 RIDGEMOOR CIR
PALM HARBOR FL
34685-3166
US

V. Phone/Fax

Practice location:
  • Phone: 727-524-9333
  • Fax:
Mailing address:
  • Phone: 727-784-1089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS30968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: