Organization
ANTONITO PHARMACY LLC
Active
Other names
Antonito Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN SANDOVAL (MANAGING PHARMACIST-OWNER)
(719) 587-3885
Entity
Organization
Contact information
Practice address
402 MAIN, ANTONITO, CO 81120
(719) 587-3885
Mailing address
402 MAIN, ANTONITO, CO 81120
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0621133
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/26/2009
Last updated
01/26/2009
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