Provider Demographics
NPI:1811642622
Name:ANYABOLU, ADANNIA
Entity type:Individual
Prefix:
First Name:ADANNIA
Middle Name:
Last Name:ANYABOLU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 OLD HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1933
Mailing Address - Country:US
Mailing Address - Phone:513-488-0908
Mailing Address - Fax:
Practice Address - Street 1:3513 OLD HOLLY DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1933
Practice Address - Country:US
Practice Address - Phone:513-488-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist