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General NPI Number Information
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NPI Number | 1104421841
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Entity Type | Individual
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Provider Name | GERALD ENDOHABE ANDU-ANZAH RPH
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Gender | Male
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 601 S JEFFERSON AVE
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City | MOUNT PLEASANT
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State | TX
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Zip | 75455-4836
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Country | US
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Telephone | 240-559-7354
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Fax |
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Provider Business Mailing Address
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Address Line | 118 ACADIA LN
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City | FORNEY
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State | TX
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Zip | 75126-4212
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Country | US
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Telephone | 240-559-7354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 63706
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License Number State | TX
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