Provider Demographics
NPI:1477060663
Name:MENEZES, ANTHONY HILDEBRAND JR
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:HILDEBRAND
Last Name:MENEZES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12917 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-5422
Mailing Address - Country:US
Mailing Address - Phone:352-256-8311
Mailing Address - Fax:
Practice Address - Street 1:4410 W NEWBERRY RD STE A5
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2290
Practice Address - Country:US
Practice Address - Phone:352-373-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist