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General NPI Number Information
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NPI Number | 1245585090
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Entity Type | Organization
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Legal Business Name | ANTELOPE PHARMACY,INC
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 4207 ELVERTA RD STE 109
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City | ANTELOPE
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State | CA
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Zip | 95843-4735
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Country | US
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Telephone | 916-729-6881
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Fax | 916-729-6882
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Provider Business Mailing Address
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Address Line | 4207 ELVERTA RD #109
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City | ANTELOPE
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State | CA
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Zip | 95843
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Country | US
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Telephone | 916-729-6881
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. NATALYA DULOGLO
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Credential |
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Telephone | 916-729-6881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY50651
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License Number State | CA
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