Provider Demographics
NPI:1689674889
Name:ANTON CORP
Entity type:Organization
Organization Name:ANTON CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:HASHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-724-7125
Mailing Address - Street 1:1031 E VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4606
Mailing Address - Country:US
Mailing Address - Phone:760-724-7125
Mailing Address - Fax:760-724-7127
Practice Address - Street 1:1031 E VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4606
Practice Address - Country:US
Practice Address - Phone:760-724-7125
Practice Address - Fax:760-724-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CAPHY505833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129753OtherPK
6660630001Medicare NSC