Individual provider Active NPI

Irina Antonova, PHARMD

  • Pharmacist
  • Fort Lauderdale, FL
National Provider Identifier
1043597123
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS41641 Issued in FL
Practice address
2855 Stirling Rd
Fort Lauderdale, FL 33312-6516
Phone
(954) 981-1107
Fax
(954) 981-1816
NPI assigned
Nov 3, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS41641 FL Primary

Addresses

Primary practice location

2855 Stirling Rd
Fort Lauderdale, FL 33312-6516

Mailing address

2053 N University Dr
Sunrise, FL 33322-3936
Phone (954) 451-5578

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
PS41641FLMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1043597123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2053 N UNIVERSITY DR",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333223936",
            "telephone_number": "954-451-5578",
            "fax_number": "954-981-1816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 STIRLING RD",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333126516",
            "telephone_number": "954-981-1107",
            "fax_number": "954-981-1816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONOVA",
        "first_name": "IRINA",
        "name_prefix": "Mrs.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-03",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS41641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.