Provider Demographics
NPI:1518581156
Name:ANTON, INAS
Entity Type:Individual
Prefix:
First Name:INAS
Middle Name:
Last Name:ANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7367 COBBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9093
Mailing Address - Country:US
Mailing Address - Phone:951-386-9199
Mailing Address - Fax:
Practice Address - Street 1:7367 COBBLE CREEK DR
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-9093
Practice Address - Country:US
Practice Address - Phone:951-386-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty