Provider Demographics
NPI:1396026159
Name:ANAST, PAUL T (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:T
Last Name:ANAST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 STIRRUP CUP CT
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-5302
Mailing Address - Country:US
Mailing Address - Phone:815-885-9060
Mailing Address - Fax:
Practice Address - Street 1:4704 STIRRUP CUP CT
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-5302
Practice Address - Country:US
Practice Address - Phone:815-885-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.029130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist