Provider Demographics
NPI:1093012825
Name:ANGLO, MICHAEL EVANGELISTA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EVANGELISTA
Last Name:ANGLO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8935 CORTE PELLEJO
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6429
Mailing Address - Country:US
Mailing Address - Phone:619-301-7611
Mailing Address - Fax:
Practice Address - Street 1:8935 CORTE PELLEJO
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-6429
Practice Address - Country:US
Practice Address - Phone:619-301-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist