Provider Demographics
NPI:1154083848
Name:SUPPA, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SUPPA
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 1:999 N EIGHTY EIGHT RD
Mailing Address - Street 2:
Mailing Address - City:RICES LANDING
Mailing Address - State:PA
Mailing Address - Zip Code:15357-1102
Mailing Address - Country:US
Mailing Address - Phone:724-592-6057
Mailing Address - Fax:
Practice Address - Street 1:999 N EIGHTY EIGHT RD
Practice Address - Street 2:
Practice Address - City:RICES LANDING
Practice Address - State:PA
Practice Address - Zip Code:15357-1102
Practice Address - Country:US
Practice Address - Phone:724-592-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040067L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist