Provider Demographics
NPI:1508083767
Name:AFFUL, ANNETTE ABA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:ANNETTE
Middle Name:ABA
Last Name:AFFUL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:FORT DETRICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-9210
Mailing Address - Country:US
Mailing Address - Phone:301-619-6710
Mailing Address - Fax:
Practice Address - Street 1:1434 PORTER ST
Practice Address - Street 2:
Practice Address - City:FORT DETRICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9210
Practice Address - Country:US
Practice Address - Phone:301-619-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist