Provider Demographics
NPI:1104421841
Name:ANDU-ANZAH, GERALD ENDOHABE (RPH)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ENDOHABE
Last Name:ANDU-ANZAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ACADIA LN
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4212
Mailing Address - Country:US
Mailing Address - Phone:240-559-7354
Mailing Address - Fax:
Practice Address - Street 1:601 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-4836
Practice Address - Country:US
Practice Address - Phone:240-559-7354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist