Provider Demographics
NPI:1518248525
Name:GUALTIERI, ANTHONY J (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:GUALTIERI
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:PO BOX 4307
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-0210
Mailing Address - Country:US
Mailing Address - Phone:404-227-0030
Mailing Address - Fax:678-880-0578
Practice Address - Street 1:120 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2303
Practice Address - Country:US
Practice Address - Phone:678-880-0575
Practice Address - Fax:678-880-0578
Is Sole Proprietor?:No
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist