Provider Demographics
NPI:1588259311
Name:CARACCI, ANGELA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:CARACCI
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 1:11160 VERISMO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3442
Mailing Address - Country:US
Mailing Address - Phone:702-862-6582
Mailing Address - Fax:
Practice Address - Street 1:6850 N DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4595
Practice Address - Country:US
Practice Address - Phone:702-470-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist