Provider Demographics
NPI:1306993662
Name:ANGELO, GLORIA H (PHARM-D)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:H
Last Name:ANGELO
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12056 HWY 21
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:WA
Mailing Address - Zip Code:99140-2056
Mailing Address - Country:US
Mailing Address - Phone:509-634-4430
Mailing Address - Fax:
Practice Address - Street 1:29 NESPELEM-SANPOIL
Practice Address - Street 2:AGENCY CAMPUS
Practice Address - City:NESPELEM
Practice Address - State:WA
Practice Address - Zip Code:99155
Practice Address - Country:US
Practice Address - Phone:509-422-7735
Practice Address - Fax:509-422-7738
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist