Provider Demographics
NPI:1154456275
Name:DEARING, ANGELA R (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:DEARING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E SHERMAN CT
Mailing Address - Street 2:
Mailing Address - City:ATHENA
Mailing Address - State:OR
Mailing Address - Zip Code:97813-6051
Mailing Address - Country:US
Mailing Address - Phone:541-566-2655
Mailing Address - Fax:
Practice Address - Street 1:46314 TIMINE WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9417
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0008347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165441Medicaid