Provider Demographics
NPI:1942017199
Name:ANEU LIFE CLINIC LLC
Entity type:Organization
Organization Name:ANEU LIFE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHINCIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:TRUDY
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-433-7014
Mailing Address - Street 1:11104 W AIRPORT BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3197
Mailing Address - Country:US
Mailing Address - Phone:281-720-6034
Mailing Address - Fax:
Practice Address - Street 1:11104 W AIRPORT BLVD STE 217
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3197
Practice Address - Country:US
Practice Address - Phone:281-720-6034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care