Provider Demographics
NPI:1386183259
Name:COX, ANGELINA CALISTA (PHARMD)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:CALISTA
Last Name:COX
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 1:203 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-6549
Mailing Address - Country:US
Mailing Address - Phone:901-568-7923
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DRIVE ATTN: CREDENTIALS OFFICE (RM # 1BED01D)
Practice Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5349
Practice Address - Country:US
Practice Address - Phone:901-568-7923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11385183500000X
KY017419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist