Provider Demographics
NPI:1972800449
Name:ANTON CORP
Entity Type:Organization
Organization Name:ANTON CORP
Other - Org Name:MED RX PHARMACY AND COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HASHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIATI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHD
Authorized Official - Phone:858-922-4439
Mailing Address - Street 1:1031 E VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4606
Mailing Address - Country:US
Mailing Address - Phone:760-724-7125
Mailing Address - Fax:760-724-7127
Practice Address - Street 1:1031 E VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4606
Practice Address - Country:US
Practice Address - Phone:760-724-7125
Practice Address - Fax:760-724-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6660630001Medicare NSC