Provider Demographics
NPI:1841522521
Name:ETUK, ANIEDI NSE (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANIEDI
Middle Name:NSE
Last Name:ETUK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3375
Mailing Address - Country:US
Mailing Address - Phone:212-222-3652
Mailing Address - Fax:212-222-3659
Practice Address - Street 1:2074 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3375
Practice Address - Country:US
Practice Address - Phone:212-222-3652
Practice Address - Fax:212-222-3659
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist