Provider Demographics
NPI:1245743277
Name:AKPAN, MFONABASI (PHARMD)
Entity Type:Individual
Prefix:
First Name:MFONABASI
Middle Name:
Last Name:AKPAN
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 1:6017 INGRAM RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-4403
Mailing Address - Country:US
Mailing Address - Phone:210-680-2962
Mailing Address - Fax:210-680-6821
Practice Address - Street 1:6017 INGRAM RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4403
Practice Address - Country:US
Practice Address - Phone:210-680-2962
Practice Address - Fax:210-680-6821
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist