Provider Demographics
NPI:1528291614
Name:ADAMS, ANGELA (RPH)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:906 N.E. BIG BEND TRAIL
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043
Mailing Address - Country:US
Mailing Address - Phone:254-897-2711
Mailing Address - Fax:254-897-3751
Practice Address - Street 1:906 N.E. BIG BEND TRAIL
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043
Practice Address - Country:US
Practice Address - Phone:254-897-2711
Practice Address - Fax:254-897-3751
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14380183500000X
TX34922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-14380OtherKANAS STATE BOARD OF PHARMACY LICENSE
TX34922OtherSTATE BOARD OF PHARMACY LICENSE NUMBER