Provider Demographics
NPI:1811509557
Name:ANENE, ANSLEM NDUDI
Entity type:Individual
Prefix:
First Name:ANSLEM
Middle Name:NDUDI
Last Name:ANENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7629
Mailing Address - Country:US
Mailing Address - Phone:915-591-9496
Mailing Address - Fax:
Practice Address - Street 1:1210 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7629
Practice Address - Country:US
Practice Address - Phone:915-591-9496
Practice Address - Fax:915-591-5884
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist