Provider Demographics
NPI:1235721887
Name:SAGRAVES, ANGELA (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SAGRAVES
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 1:6175 HI TEK CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2603
Mailing Address - Country:US
Mailing Address - Phone:513-919-3083
Mailing Address - Fax:
Practice Address - Street 1:9299 MARKET PL
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2865
Practice Address - Country:US
Practice Address - Phone:513-919-3083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-21245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist