=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700038205
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH BRION ANTINORO RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2008
-----------------------------------------------------
Last Update Date | 10/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E MINERAL AVE
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-795-0043
-----------------------------------------------------
Fax | 303-795-0087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7016 CHATFORD CT
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80108-3466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-663-6656
-----------------------------------------------------
Fax | 303-795-0087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 15266
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 044460
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------