Provider Demographics
NPI:1114619087
Name:ANGUS, JONATHAN (PHARMD, BCOP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ANGUS
Suffix:
Gender:M
Credentials:PHARMD, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:ME
Mailing Address - Zip Code:04054-0186
Mailing Address - Country:US
Mailing Address - Phone:207-332-7273
Mailing Address - Fax:
Practice Address - Street 1:340 COUNTY RD STE 3
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-1901
Practice Address - Country:US
Practice Address - Phone:207-332-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERP713091835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology