Provider Demographics
NPI:1093559361
Name:SQUIRES, ANGELA CAROL (RPH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CAROL
Last Name:SQUIRES
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 1:1415 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-5137
Mailing Address - Country:US
Mailing Address - Phone:806-549-0948
Mailing Address - Fax:
Practice Address - Street 1:6101 43RD ST STE C
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-3749
Practice Address - Country:US
Practice Address - Phone:806-791-4663
Practice Address - Fax:806-791-1918
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist