Healthcare Provider Details

I. General information

NPI: 1992501068
Provider Name (Legal Business Name): ST. ANTONY PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E GRAND AVE STE 104
EL SEGUNDO CA
90245-3871
US

IV. Provider business mailing address

310 E GRAND AVE STE 104
EL SEGUNDO CA
90245-3871
US

V. Phone/Fax

Practice location:
  • Phone: 310-524-9244
  • Fax:
Mailing address:
  • Phone: 310-524-9244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EMAD MICHAEL
Title or Position: PIC
Credential:
Phone: 310-524-9244