Provider Demographics
NPI:1255673372
Name:BLACKWELL, ANGELA ROYALE
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:ROYALE
Last Name:BLACKWELL
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 1:4500 MONTEVALLO RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210
Mailing Address - Country:US
Mailing Address - Phone:205-215-2417
Mailing Address - Fax:
Practice Address - Street 1:4500 MONTEVALLO RD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-3129
Practice Address - Country:US
Practice Address - Phone:205-215-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist