Provider Demographics
NPI:1427104587
Name:MEOLA, ANTHONY (RPH,CPH)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:MEOLA
Suffix:
Gender:M
Credentials:RPH,CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7641 NW 13TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4705
Mailing Address - Country:US
Mailing Address - Phone:954-370-6684
Mailing Address - Fax:
Practice Address - Street 1:5816 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4634
Practice Address - Country:US
Practice Address - Phone:954-726-1911
Practice Address - Fax:954-726-7023
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS22173OtherPHARMACIST LICENSE #