Provider Demographics
NPI:1720369457
Name:ALVIS, ANTHONY ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ALLEN
Last Name:ALVIS
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 1:20021 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1625
Mailing Address - Country:US
Mailing Address - Phone:708-479-5733
Mailing Address - Fax:
Practice Address - Street 1:7960 W 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5038
Practice Address - Country:US
Practice Address - Phone:708-532-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.029521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist