Provider Demographics
NPI:1750644738
Name:GIANNANTONIO, PATRICK JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOHN
Last Name:GIANNANTONIO
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 1:426 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-2145
Mailing Address - Country:US
Mailing Address - Phone:712-737-2151
Mailing Address - Fax:
Practice Address - Street 1:104 ALBANY AVE NE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1423
Practice Address - Country:US
Practice Address - Phone:712-737-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist