Provider Demographics
NPI:1407098148
Name:CARILLI, ANTHONY R (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:R
Last Name:CARILLI
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 1:9121 N, MILITARY TRAIL SUITE
Mailing Address - Street 2:SUITE# 106
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-254-0431
Mailing Address - Fax:
Practice Address - Street 1:9121 N MILITARY TRAIL
Practice Address - Street 2:SUITE# 106
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-254-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist