Provider Demographics
NPI:1881952349
Name:ANEKWE, BENEDICT C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:C
Last Name:ANEKWE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:518 1ST ST NE
Mailing Address - Street 2:APT 2
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-7204
Mailing Address - Country:US
Mailing Address - Phone:219-805-4517
Mailing Address - Fax:
Practice Address - Street 1:518 1ST ST NE
Practice Address - Street 2:APT 2
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-7204
Practice Address - Country:US
Practice Address - Phone:219-805-4517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNSHU334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist