MEDICARE: ANTHONYS PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	28RS00105200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2122177	OTHER	PK

General Provider Information

NPI Number	:	1447391768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONYS PHARMACY LLC

Provider Business Mailing Address
First Line	:	341 BROAD AVE
Second Line	:
City	:	PALISADES PARK
State	:	NJ
Zip	:	07650-1656
Country	:	US
Telephone Number	:	201-944-2720
Fax Number	:	201-944-9536

Provider Business Practice Location Address
First Line	:	341 BROAD AVE
Second Line	:
City	:	PALISADES PARK
State	:	NJ
Zip	:	07650-1656
Country	:	US
Telephone Number	:	201-944-2720
Fax Number	:	201-944-9536

Authorized Official
Title or Position	:	PIC
Name	:	MICHAEL GIANNANTONIO
Credential	:
Telephone Number	:	201-944-2720

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/25/2016

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Directions to “ANTHONYS PHARMACY LLC ” Practice Location

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