Provider Demographics
NPI:1003365545
Name:ADANE, AMANUEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANUEL
Middle Name:
Last Name:ADANE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W PARKERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8074
Mailing Address - Country:US
Mailing Address - Phone:214-830-3587
Mailing Address - Fax:
Practice Address - Street 1:108 W PARKERVILLE RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8074
Practice Address - Country:US
Practice Address - Phone:469-643-5017
Practice Address - Fax:469-643-5014
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist