Provider Demographics
NPI:1699497222
Name:ANGELOS, LISA MAUREEN (PHARMD, BCSCP, CAPP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MAUREEN
Last Name:ANGELOS
Suffix:
Gender:F
Credentials:PHARMD, BCSCP, CAPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 S YUBA WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5547
Mailing Address - Country:US
Mailing Address - Phone:801-647-3537
Mailing Address - Fax:
Practice Address - Street 1:10221 S YUBA WAY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5547
Practice Address - Country:US
Practice Address - Phone:801-647-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7054807-17011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist