Provider Demographics
NPI:1114227600
Name:MAH, ANGELA V (RPH)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:V
Last Name:MAH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 QUEEN ANNE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2309
Mailing Address - Country:US
Mailing Address - Phone:206-284-4226
Mailing Address - Fax:206-281-9109
Practice Address - Street 1:2100 QUEEN ANNE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2309
Practice Address - Country:US
Practice Address - Phone:206-284-4226
Practice Address - Fax:206-281-9109
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60072197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist