Provider Demographics
NPI:1508466020
Name:MANYAZEWAL, ASNAKE SHIMELS
Entity Type:Individual
Prefix:
First Name:ASNAKE
Middle Name:SHIMELS
Last Name:MANYAZEWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 W FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2313
Mailing Address - Country:US
Mailing Address - Phone:956-782-2156
Mailing Address - Fax:956-782-2774
Practice Address - Street 1:1421 W FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2313
Practice Address - Country:US
Practice Address - Phone:956-782-2156
Practice Address - Fax:956-782-2774
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist