Provider Demographics
NPI:1194176370
Name:ANGEL, ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ANGEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 W LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2660
Mailing Address - Country:US
Mailing Address - Phone:702-631-2040
Mailing Address - Fax:702-631-8611
Practice Address - Street 1:6151 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2660
Practice Address - Country:US
Practice Address - Phone:702-631-2040
Practice Address - Fax:702-631-8611
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist