Provider Demographics
NPI:1700386497
Name:PANICI, ANTHONY (RPH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PANICI
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 1:222 STONE CT
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1598
Mailing Address - Country:US
Mailing Address - Phone:779-205-3184
Mailing Address - Fax:
Practice Address - Street 1:222 STONE CT
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1598
Practice Address - Country:US
Practice Address - Phone:779-205-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510382571835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care