Provider Demographics
NPI:1306445382
Name:ANTONIADES, KATHERINE L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:L
Last Name:ANTONIADES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:LALAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2759 THOMASHIRE TRCE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4783
Mailing Address - Country:US
Mailing Address - Phone:864-593-2177
Mailing Address - Fax:
Practice Address - Street 1:4880 LOWER ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4375
Practice Address - Country:US
Practice Address - Phone:770-971-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0207931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist