Provider Demographics
NPI:1225461478
Name:ANGEL, MARILYN WANDA (RPH)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:WANDA
Last Name:ANGEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:WANDA
Other - Last Name:ANGEL-JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:123 ALEASHA LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7300
Mailing Address - Country:US
Mailing Address - Phone:724-837-1905
Mailing Address - Fax:
Practice Address - Street 1:8001 LINCOLN AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3695
Practice Address - Country:US
Practice Address - Phone:800-553-7359
Practice Address - Fax:847-588-7060
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035221L183500000X
NC17952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist