Provider Demographics
NPI:1891910493
Name:MINNITI, ANTONIO V (RPH)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:V
Last Name:MINNITI
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 1:302 WHITEBIRCH DR
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-4396
Mailing Address - Country:US
Mailing Address - Phone:856-786-9139
Mailing Address - Fax:856-786-2313
Practice Address - Street 1:1201 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3105
Practice Address - Country:US
Practice Address - Phone:856-963-4742
Practice Address - Fax:856-541-8580
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02248200183500000X
FLPS30911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist