Provider Demographics
NPI:1396172169
Name:HOUSE, ANGELA (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-9689
Mailing Address - Country:US
Mailing Address - Phone:740-826-4292
Mailing Address - Fax:
Practice Address - Street 1:153 MULBERRY LN
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-9689
Practice Address - Country:US
Practice Address - Phone:740-826-4292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3124412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist