Basic Information
| Provider Information | |||||||||
| NPI: | 1003148255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTHONY | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1603 TEXAS AVE | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324013959 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2419 THOMAS DR | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324085808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502364420 | ||||||||
| FaxNumber: | 8502364425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2010 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS19034 | FL | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 10069 | AL | N | Pharmacy Service Providers | Pharmacist |
No ID Information.