Provider Demographics
NPI:1134318199
Name:NELSON, ANGELA KAYE (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAYE
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-2116
Mailing Address - Country:US
Mailing Address - Phone:515-386-4151
Mailing Address - Fax:515-386-3526
Practice Address - Street 1:100 N WILSON AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-2116
Practice Address - Country:US
Practice Address - Phone:515-386-4151
Practice Address - Fax:515-386-3526
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA19530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist