Provider Demographics
NPI:1558648378
Name:ANKUTSE, JONATHAN MAWUNYO (PHARMD; MS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MAWUNYO
Last Name:ANKUTSE
Suffix:
Gender:M
Credentials:PHARMD; MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-0125
Mailing Address - Country:US
Mailing Address - Phone:832-445-0972
Mailing Address - Fax:
Practice Address - Street 1:496 HIGHWAY 96 S
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-4810
Practice Address - Country:US
Practice Address - Phone:409-386-6959
Practice Address - Fax:409-386-6029
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist