Healthcare Provider Details

I. General information

NPI: 1477060663
Provider Name (Legal Business Name): ANTHONY HILDEBRAND MENEZES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W NEWBERRY RD STE A5
GAINESVILLE FL
32607-2290
US

IV. Provider business mailing address

12917 SW 2ND AVE
NEWBERRY FL
32669-5422
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-8111
  • Fax:
Mailing address:
  • Phone: 352-256-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS42071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: