Individual provider Active NPI

Demetra Elizabeth Antimisiaris, PHARMD

  • Geriatric Pharmacist
  • Louisville, KY
National Provider Identifier
1376726836
Registry record updated Dec 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric PharmacistTaxonomy code 1835G0303X
License
013872 Issued in KY
Practice address
501 E Broadway
Suite 204
Louisville, KY 40202-1785
Phone
(502) 852-2813
Fax
(502) 852-0415
NPI assigned
Dec 7, 2007
Last updated
Dec 7, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Pharmacist 1835G0303X 013872 KY Primary

Addresses

Primary practice location

501 E Broadway
Suite 204
Louisville, KY 40202-1785

Mailing address

501 E Broadway Ste 204
Univ. of Louisville:Dept. of Family & Geriatric Med
Louisville, KY 40202-1785
Phone (502) 852-2813

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
013872KYMDGeriatric Pharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196985600000",
    "number": "1376726836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 E BROADWAY STE 204",
            "address_2": "UNIV. OF LOUISVILLE:DEPT. OF FAMILY & GERIATRIC MED",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021785",
            "telephone_number": "502-852-2813",
            "fax_number": "502-852-0415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 E BROADWAY",
            "address_2": "SUITE 204",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021785",
            "telephone_number": "502-852-2813",
            "fax_number": "502-852-0415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTIMISIARIS",
        "first_name": "DEMETRA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-07",
        "last_updated": "2007-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835G0303X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Geriatric",
            "state": "KY",
            "license": "013872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.