Provider Demographics
NPI:1013022763
Name:GREEN, ANGELA KAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:KAY
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:KAY
Other - Last Name:HERZOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:450 N BUYS RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2226
Mailing Address - Country:US
Mailing Address - Phone:231-744-3444
Mailing Address - Fax:
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1849
Practice Address - Country:US
Practice Address - Phone:231-672-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist