Provider Demographics
NPI:1134493810
Name:NORTH ANTHONY PHARMACY & WELLNESS CENTER INC
Entity Type:Organization
Organization Name:NORTH ANTHONY PHARMACY & WELLNESS CENTER INC
Other - Org Name:NORTH ANTHONY PHARMACY & WELLNESS CENTER INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-320-4000
Mailing Address - Street 1:3537 N ANTHONY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-1423
Mailing Address - Country:US
Mailing Address - Phone:260-373-1083
Mailing Address - Fax:260-739-3927
Practice Address - Street 1:3537 N ANTHONY BLVD STE A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1423
Practice Address - Country:US
Practice Address - Phone:260-373-1083
Practice Address - Fax:260-739-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336M0002X, 3336S0011X
IN60006291A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133936OtherPK