Provider Demographics
NPI:1407563828
Name:SAINT ANTHONY PHARMACY
Entity Type:Organization
Organization Name:SAINT ANTHONY PHARMACY
Other - Org Name:PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-484-4783
Mailing Address - Street 1:2001 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2486
Mailing Address - Country:US
Mailing Address - Phone:773-484-4783
Mailing Address - Fax:
Practice Address - Street 1:2875 W. 19TH STREET
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-6062
Practice Address - Country:US
Practice Address - Phone:773-484-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy