# ANTONACCI INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDICINE STOP OF PEORIA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841336450
- **Authorized official:** ROBERT ANTONACCI RPH (PHARMACIST AND PRESIDENT)
- **Authorized official phone:** (309) 685-5939

## Contact information

- **Practice address:** 4410 N KNOXVILLE AVE, STE A, PEORIA, IL 61614-6086
- **Practice address phone:** (309) 685-5939
- **Practice address fax:** (309) 685-5930
- **Mailing address:** 4410 N KNOXVILLE AVE, STE A, PEORIA, IL 61614-6086
- **Mailing address phone:** (309) 685-5939
- **Mailing address fax:** (309) 685-5930

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054009135 | IL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 04/12/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1454545 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |