Provider Demographics
NPI:1386121663
Name:HAZELWOOD, ANGELA LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:HAZELWOOD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 DIETRICH LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2638
Mailing Address - Country:US
Mailing Address - Phone:252-514-8509
Mailing Address - Fax:
Practice Address - Street 1:1895 E FIRE TOWER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4132
Practice Address - Country:US
Practice Address - Phone:252-756-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist