Provider Demographics
NPI:1194011239
Name:ELVERS, ANGELA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:ELVERS
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 1:4199 MORSE XING
Mailing Address - Street 2:TARGET PHARMACY T-1072
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6015
Mailing Address - Country:US
Mailing Address - Phone:614-471-3264
Mailing Address - Fax:614-471-3264
Practice Address - Street 1:4199 MORSE XING
Practice Address - Street 2:TARGET PHARMACY T-1072
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6015
Practice Address - Country:US
Practice Address - Phone:614-471-3264
Practice Address - Fax:614-471-3264
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03324027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist