Provider Demographics
NPI:1154873941
Name:ANAKO, NKECHI ALEXANDRA
Entity type:Individual
Prefix:
First Name:NKECHI
Middle Name:ALEXANDRA
Last Name:ANAKO
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 1:1702 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4206
Mailing Address - Country:US
Mailing Address - Phone:267-664-3694
Mailing Address - Fax:
Practice Address - Street 1:1702 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4206
Practice Address - Country:US
Practice Address - Phone:903-526-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4527531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist