Provider Demographics
NPI:1851990204
Name:ANAYA, JESUS ULISES (RPH)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ULISES
Last Name:ANAYA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6102
Mailing Address - Country:US
Mailing Address - Phone:832-298-9568
Mailing Address - Fax:281-842-1023
Practice Address - Street 1:1300 W FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6102
Practice Address - Country:US
Practice Address - Phone:832-298-9568
Practice Address - Fax:281-842-1023
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX361551835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist