Provider Demographics
NPI:1043696222
Name:RENCKLY, ANGELA NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:NICOLE
Last Name:RENCKLY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:NICOLE
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9003 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6709
Mailing Address - Country:US
Mailing Address - Phone:480-323-3854
Mailing Address - Fax:
Practice Address - Street 1:9003 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6709
Practice Address - Country:US
Practice Address - Phone:480-323-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist