NPIMap

Organization Active NPI

Antonito Pharmacy LLC

  • Community/Retail Pharmacy
  • Antonito, CO
National Provider Identifier
1295973493
Registry record updated Jan 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
ANTONITO PHARMACY LLC
Doing business as
Antonito Pharmacy LLC
Practice address
402 Main
Antonito, CO 81120
Phone
(719) 587-3885
NPI assigned
Jan 26, 2009
Last updated
Jan 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2009

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

Authorized official

Name
Bryan SandovalNPI 1447401963
Title
Managing Pharmacist-Owner
Phone
(719) 587-3885

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

402 Main
Antonito, CO 81120

Mailing address

402 Main
Antonito, CO 81120

Other identifiers 1

IdentifierTypeStateIssuer
0621133OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Antonito Pharmacy LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1232928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232928000000",
    "number": "1295973493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 MAIN",
            "city": "ANTONITO",
            "state": "CO",
            "postal_code": "81120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 MAIN",
            "city": "ANTONITO",
            "state": "CO",
            "postal_code": "81120",
            "telephone_number": "719-587-3885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTONITO PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-26",
        "last_updated": "2009-01-26",
        "status": "A",
        "authorized_official_last_name": "SANDOVAL",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "MANAGING PHARMACIST-OWNER",
        "authorized_official_telephone_number": "719-587-3885"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0621133",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Antonito Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Antonito, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2009; 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.