Provider Demographics
NPI:1447391768
Name:ANTHONYS PHARMACY LLC
Entity Type:Organization
Organization Name:ANTHONYS PHARMACY LLC
Other - Org Name:ANTHONY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-944-2720
Mailing Address - Street 1:341 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1656
Mailing Address - Country:US
Mailing Address - Phone:201-944-2720
Mailing Address - Fax:201-944-9536
Practice Address - Street 1:341 BROAD AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1656
Practice Address - Country:US
Practice Address - Phone:201-944-2720
Practice Address - Fax:201-944-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS001052003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0220655Medicaid
NJ0220647Medicaid
2122177OtherPK
NJ0220647Medicaid