Provider Demographics
NPI:1881044642
Name:ANTHONY 2016 LLC
Entity Type:Organization
Organization Name:ANTHONY 2016 LLC
Other - Org Name:ST ANTHONY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:727-729-0313
Mailing Address - Street 1:1983 LAGO VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3333
Mailing Address - Country:US
Mailing Address - Phone:813-570-7444
Mailing Address - Fax:813-570-6090
Practice Address - Street 1:2513 W HILLSBOROUGH AVE
Practice Address - Street 2:107
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6122
Practice Address - Country:US
Practice Address - Phone:813-570-7444
Practice Address - Fax:813-570-6090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH30196OtherPHARMACY LICENSE
FL019580500Medicaid