Provider Demographics
NPI:1154734986
Name:ANGELES, RANDY (RPH)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:ANGELES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4060
Mailing Address - Country:US
Mailing Address - Phone:757-318-9305
Mailing Address - Fax:757-318-3542
Practice Address - Street 1:1660 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4060
Practice Address - Country:US
Practice Address - Phone:757-318-9305
Practice Address - Fax:757-318-3542
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist