Provider Demographics
NPI:1790907426
Name:D'ANTONIO, PATRICIA M (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:D'ANTONIO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 YOAKUM PKWY
Mailing Address - Street 2:UNIT 1123
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4051
Mailing Address - Country:US
Mailing Address - Phone:703-751-0005
Mailing Address - Fax:
Practice Address - Street 1:307 YOAKUM PKWY
Practice Address - Street 2:UNIT 1123
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4051
Practice Address - Country:US
Practice Address - Phone:703-751-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-035269-L183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric