Healthcare Provider Details

I. General information

NPI: 1255935300
Provider Name (Legal Business Name): ANTO STANIC PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2020
Last Update Date: 11/29/2020
Certification Date: 11/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 GULFPORT BLVD S
SOUTH PASADENA FL
33707-2108
US

IV. Provider business mailing address

6820 GULFPORT BLVD S
SOUTH PASADENA FL
33707-2108
US

V. Phone/Fax

Practice location:
  • Phone: 727-345-9103
  • Fax:
Mailing address:
  • Phone: 727-345-9103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPS60814
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: