Provider Demographics
NPI:1609209071
Name:ANOSIKE, PETRONILLA
Entity Type:Individual
Prefix:DR
First Name:PETRONILLA
Middle Name:
Last Name:ANOSIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 ELDORADO DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6350
Mailing Address - Country:US
Mailing Address - Phone:214-714-3341
Mailing Address - Fax:
Practice Address - Street 1:2200 E PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5243
Practice Address - Country:US
Practice Address - Phone:817-860-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist