Organization
ANTIS PHARMACY,INC
Active
Other names
Osman Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK D ANTIS RPH (PRESIDENT)
(606) 796-2932
Entity
Organization
Contact information
Practice address
89 SECOND ST, VANCEBURG, KY 41179-5439
(606) 796-2932
(606) 796-2124
Mailing address
89 SECOND ST, VANCEBURG, KY 41179-5439
(606) 796-2932
(606) 796-2124
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
90040684
KY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
P06079
KY
333600000X
Pharmacy
Primary
P06079
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0187766
—
OH
01
—
45540010
EPSDT- SPECIAL SERVICES
KY
05
—
54030077
—
KY
01
—
90040684
MEDICAID DME
KY
Enumeration date
01/31/2007
Last updated
05/26/2010
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