Provider Demographics
NPI:1174808414
Name:EKOBENA, ANNE FELICITA (PHARMD)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:FELICITA
Last Name:EKOBENA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6941 PRAIRIE CT S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4598
Mailing Address - Country:US
Mailing Address - Phone:612-229-4359
Mailing Address - Fax:
Practice Address - Street 1:2426 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2604
Practice Address - Country:US
Practice Address - Phone:612-377-3308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118100-9183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist