Provider Demographics
NPI:1043597123
Name:ANTONOVA, IRINA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:ANTONOVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3936
Mailing Address - Country:US
Mailing Address - Phone:954-451-5578
Mailing Address - Fax:954-981-1816
Practice Address - Street 1:2855 STIRLING RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6516
Practice Address - Country:US
Practice Address - Phone:954-981-1107
Practice Address - Fax:954-981-1816
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist