Provider Demographics
NPI:1790306371
Name:AHARANWA, AMANZE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:AMANZE
Middle Name:
Last Name:AHARANWA
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 ZEKE LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-2029
Mailing Address - Country:US
Mailing Address - Phone:817-692-2386
Mailing Address - Fax:
Practice Address - Street 1:611 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-1008
Practice Address - Country:US
Practice Address - Phone:817-996-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist