Michael Anthony

Individual provider Active NPI Pharmacist · Bryan, TX

NPI 1487256384 · NPPES record last updated Nov 15, 2020

Key facts

NPI
1487256384
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist 183500000X
License
35865 (TX)
Practice address
3214 Rose Hill LN
Bryan, TX 77808-1475
Phone
(979) 777-9068
Fax
(979) 458-8294
NPI assigned
Nov 15, 2020
Sex
Male
Sole proprietor
Yes

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
35865TXMDPharmacist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist
Group: 193400000X SINGLE SPECIALTY GROUP
183500000X 35865 TX Yes

Addresses

Primary practice location

3214 Rose Hill LN
Bryan, TX 77808-1475

Mailing address

3214 Rose Hill LN
Bryan, TX 77808-1475
Phone (979) 777-9068

Other providers in Bryan, TX

All providers in Bryan, TX · Pharmacist in Texas

Sources for this page

Verify at the official NPI Registry.