Provider Demographics
NPI:1184002321
Name:EHULE, ANYASOR VINCENT (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANYASOR
Middle Name:VINCENT
Last Name:EHULE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HIDDEN LAKES CT # 2
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-5068
Mailing Address - Country:US
Mailing Address - Phone:678-643-2191
Mailing Address - Fax:
Practice Address - Street 1:343 W TRILBY ST
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-2142
Practice Address - Country:US
Practice Address - Phone:478-864-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0139421835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH 013942OtherPHARMACIST LICENSE NUMBER