Provider Demographics
NPI:1033838461
Name:ANTONUS, RAGWA (RPH)
Entity Type:Individual
Prefix:
First Name:RAGWA
Middle Name:
Last Name:ANTONUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6860
Mailing Address - Country:US
Mailing Address - Phone:407-977-5613
Mailing Address - Fax:407-977-5620
Practice Address - Street 1:8315 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6860
Practice Address - Country:US
Practice Address - Phone:407-590-7084
Practice Address - Fax:407-977-5620
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist