MEDICARE: MRS. ANNA G ANTIARIS

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	183500000X	Pharmacist	041645	NY
2	1835P1200X	Pharmacotherapy Pharmacist	041645	NY

General Provider Information

NPI Number	:	1982873840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA G ANTIARIS

Provider Business Mailing Address
First Line	:	16004 14TH AVE
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-2713
Country	:	US
Telephone Number	:	718-767-2447
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 CENTRAL PARK AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10710-2828
Country	:	US
Telephone Number	:	914-961-2355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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