Provider Demographics
NPI:1093319154
Name:USHER, ANGELA LYN
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYN
Last Name:USHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9080 COUNTY LANE 212
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-9211
Mailing Address - Country:US
Mailing Address - Phone:918-991-5508
Mailing Address - Fax:
Practice Address - Street 1:2623 W 7TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3300
Practice Address - Country:US
Practice Address - Phone:417-624-1111
Practice Address - Fax:417-624-9094
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009013473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist