Healthcare Provider Details

I. General information

NPI: 1740249283
Provider Name (Legal Business Name): JOHN C PANTOURIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 KIMEL PARK DR
WINSTON SALEM NC
27103-6946
US

IV. Provider business mailing address

190 KIMEL PARK DR
WINSTON SALEM NC
27103-6946
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3296
  • Fax: 336-760-5484
Mailing address:
  • Phone: 336-768-3296
  • Fax: 336-760-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS35700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: