Provider Demographics
NPI:1225844731
Name:FANLO, ANIKA (PHARMD)
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:FANLO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 WESTGATE APT 326
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-4057
Mailing Address - Country:US
Mailing Address - Phone:908-420-6576
Mailing Address - Fax:
Practice Address - Street 1:990 S HIGHWAY 395
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2699
Practice Address - Country:US
Practice Address - Phone:541-564-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0020345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist