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General NPI Number Information
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NPI Number | 1043597123
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Entity Type | Individual
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Provider Name | IRINA ANTONOVA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 2855 STIRLING RD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-6516
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Country | US
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Telephone | 954-981-1107
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Fax | 954-981-1816
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Provider Business Mailing Address
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Address Line | 2053 N UNIVERSITY DR
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City | SUNRISE
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State | FL
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Zip | 33322-3936
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Country | US
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Telephone | 954-451-5578
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Fax | 954-981-1816
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS41641
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License Number State | FL
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