Provider Demographics
NPI:1255686937
Name:PURCELL, CATHERINE ANGELICA (RPH)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANGELICA
Last Name:PURCELL
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 1:510 OAK FOREST CT
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-5602
Mailing Address - Country:US
Mailing Address - Phone:817-372-9725
Mailing Address - Fax:817-590-2489
Practice Address - Street 1:2631 GRAVEL DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-6982
Practice Address - Country:US
Practice Address - Phone:817-590-0073
Practice Address - Fax:817-590-2489
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist