Provider Demographics
NPI:1770883480
Name:ANYANWU, JOHNKENNEDY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHNKENNEDY
Middle Name:
Last Name:ANYANWU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 CREEK FALLS DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5187
Mailing Address - Country:US
Mailing Address - Phone:214-256-3882
Mailing Address - Fax:
Practice Address - Street 1:4209 CREEK FALLS DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5187
Practice Address - Country:US
Practice Address - Phone:214-256-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX454731835P0018X
MD183111835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist