Provider Demographics
NPI:1588705420
Name:ANTHONYS PHARMACY LLC
Entity type:Organization
Organization Name:ANTHONYS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-945-5503
Mailing Address - Street 1:676 SHALER BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1749
Mailing Address - Country:US
Mailing Address - Phone:201-945-5503
Mailing Address - Fax:201-945-6284
Practice Address - Street 1:676 SHALER BLVD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1749
Practice Address - Country:US
Practice Address - Phone:201-945-5503
Practice Address - Fax:201-945-6284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS002898003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0220671Medicaid
2122178OtherPK
NJ0221015Medicaid
NJ0220671Medicaid