Provider Demographics
NPI:1477647717
Name:CARUSO, ANTONIO (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:CARUSO
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 1:802 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-4916
Mailing Address - Country:US
Mailing Address - Phone:863-452-6228
Mailing Address - Fax:
Practice Address - Street 1:802 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-4916
Practice Address - Country:US
Practice Address - Phone:863-452-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0015877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102803100Medicaid
FL102803100Medicaid