Healthcare Provider Details

I. General information

NPI: 1063069862
Provider Name (Legal Business Name): ANITTA JAMES AICKARETH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

7114 CRANFORD CT
SUGAR LAND TX
77479-5630
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2488
  • Fax:
Mailing address:
  • Phone: 281-739-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65548
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: