Provider Demographics
NPI:1104489806
Name:ANGADI, SHAUN
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:ANGADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MALCOLM DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6110
Mailing Address - Country:US
Mailing Address - Phone:410-848-2152
Mailing Address - Fax:
Practice Address - Street 1:200 MALCOLM DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6110
Practice Address - Country:US
Practice Address - Phone:410-848-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2020-11-18
Deactivation Date:2019-12-31
Deactivation Code:
Reactivation Date:2020-11-18
Provider Licenses
StateLicense IDTaxonomies
MD23997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist