MEDICARE: ST. ANTONY PHARMACY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609822519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. ANTONY PHARMACY INC.

Provider Business Mailing Address
First Line	:	310 E GRAND AVE STE 105
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-3871
Country	:	US
Telephone Number	:	310-524-9244
Fax Number	:	310-524-9592

Provider Business Practice Location Address
First Line	:	310 E GRAND AVE STE 105
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-3871
Country	:	US
Telephone Number	:	310-524-9244
Fax Number	:	310-524-9592

Authorized Official
Title or Position	:	OWNER PHARMACIST IN CHARGE
Name	:	EMAD MICHAEL
Credential	:
Telephone Number	:	310-524-9244

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/08/2022

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Directions to “ST. ANTONY PHARMACY INC. ” Practice Location

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