Provider Demographics
NPI:1760776496
Name:OLIVA, ANTHONY JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:OLIVA
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 1:706 E EMERY DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1250
Mailing Address - Country:US
Mailing Address - Phone:719-547-7589
Mailing Address - Fax:
Practice Address - Street 1:3900 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2518
Practice Address - Country:US
Practice Address - Phone:719-564-4332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO152791835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric