Healthcare Provider Details

I. General information

NPI: 1134493810
Provider Name (Legal Business Name): NORTH ANTHONY PHARMACY & WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3537 N ANTHONY BLVD STE A
FORT WAYNE IN
46805-1423
US

IV. Provider business mailing address

3537 N ANTHONY BLVD STE A
FORT WAYNE IN
46805-1423
US

V. Phone/Fax

Practice location:
  • Phone: 260-373-1083
  • Fax: 260-739-3927
Mailing address:
  • Phone: 260-373-1083
  • Fax: 260-739-3927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60006291A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRENT LOSIER
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 812-320-4000