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General NPI Number Information
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NPI Number | 1942017199
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Entity Type | Organization
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Legal Business Name | ANEU LIFE CLINIC LLC
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 11104 W AIRPORT BLVD STE 217
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City | STAFFORD
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State | TX
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Zip | 77477-3197
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Country | US
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Telephone | 281-720-6034
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Fax |
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Provider Business Mailing Address
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Address Line | 11104 W AIRPORT BLVD STE 217
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City | STAFFORD
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State | TX
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Zip | 77477-3197
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Country | US
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Telephone | 281-720-6034
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Fax |
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Authorized Official
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Title or Position | PHARMACY TECHINCIAN
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Name | MICHELE TRUDY NOEL
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Credential |
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Telephone | 718-433-7014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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