Provider Demographics
NPI:1053090308
Name:ANASTASIA, ANTHONY DANIEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DANIEL
Last Name:ANASTASIA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4447 N KEDZIE AVE APT 312
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6636
Mailing Address - Country:US
Mailing Address - Phone:708-373-0680
Mailing Address - Fax:
Practice Address - Street 1:2800 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-5107
Practice Address - Country:US
Practice Address - Phone:773-674-5622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.303179183500000X
IN26025632A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist