Provider Demographics
NPI:1902400781
Name:O ASANTE JR, MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:O ASANTE JR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:OSAE ASANTE JR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1484 RUBEN TORRES SR BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-1537
Mailing Address - Country:US
Mailing Address - Phone:956-541-0167
Mailing Address - Fax:
Practice Address - Street 1:1484 RUBEN TORRES SR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-1537
Practice Address - Country:US
Practice Address - Phone:956-541-0167
Practice Address - Fax:956-554-4986
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist