Provider Demographics
NPI:1386012557
Name:ANTAL, ANDREA MELINDA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MELINDA
Last Name:ANTAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ICE CREAM ALY
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3827
Mailing Address - Country:US
Mailing Address - Phone:215-579-0864
Mailing Address - Fax:
Practice Address - Street 1:1 ICE CREAM ALY
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3827
Practice Address - Country:US
Practice Address - Phone:215-579-0864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist