Healthcare Provider Details

I. General information

NPI: 1114979317
Provider Name (Legal Business Name): ANTHONY JOSEPH CERNY R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 JOHN RICH SCHOOL RD
ANNA IL
62906-3104
US

IV. Provider business mailing address

1575 JOHN RICH SCHOOL ROAD
ANNA IL
62906
US

V. Phone/Fax

Practice location:
  • Phone: 618-893-4594
  • Fax:
Mailing address:
  • Phone: 618-893-4594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051034869
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: