Provider Demographics
NPI:1023013844
Name:BALLOU, ANGELA KAY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:KAY
Last Name:BALLOU
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37186-2942
Mailing Address - Country:US
Mailing Address - Phone:615-688-6337
Mailing Address - Fax:615-688-6338
Practice Address - Street 1:207 HIGHWAY 52 BYP W
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1728
Practice Address - Country:US
Practice Address - Phone:615-688-6337
Practice Address - Fax:615-688-6338
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist