MEDICARE: ANTONIO 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	3336C0003X	Community/Retail Pharmacy	PH23649	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1040156	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1851542674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTONIO PHARMACY LLC

Provider Business Mailing Address
First Line	:	7202 SOUTHGATE BLVD
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-1426
Country	:	US
Telephone Number	:	954-721-0325
Fax Number	:	866-551-3911

Provider Business Practice Location Address
First Line	:	7202 SOUTHGATE BLVD
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-1426
Country	:	US
Telephone Number	:	954-721-0325
Fax Number	:	866-551-3911

Authorized Official
Title or Position	:	PHARMACIST
Name	:	ANTHONY SALAMI
Credential	:
Telephone Number	:	954-721-0325

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	02/20/2013

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Directions to “ANTONIO PHARMACY LLC ” Practice Location

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